Genesis Community Resource Center

NPI 1013231117 - Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities - 320900000X

NPI Details
NPI 1013231117
Enumeration Date 03/17/2010
Last Updated 03/17/2010
Entity Type Healthcare Provider
Active Over 6 years ago
Authorized Information
Name SHANDA RENA SHANDA
Position ADMINISTRATOR
Phone (708) 654-6324
Fax
Practice Location
11616 BARBERRY CT
SAINT JOHN IN, 46373-9690, US
Phone (708) 654-6324
Fax
Business Location
320 W RIDGE RD
GARY IN, 46408-2735, US
Phone (219) 884-1402
Fax
Toxanomy
Taxonomy Code 320900000X
License State
License Number
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According to our database, Genesis Community Resource Center NPI is 1013231117, taxonomy code is 320900000X Genesis Community Resource Center physically located at 11616 Barberry Ct, Saint John IN, 46373-9690. NPI Number 1033115704 has the healthcare provider type.

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1013231117 NPI number is provided on an as is basis without warranty of any kind. 1013231117 is maintained by the National Plan & Provider Enumeration System. The contents of Genesis Community Resource Center are for informational purposes only.