Provider Demographics
NPI:1134331077
Name:GENESIS HOUSE
Entity Type:Organization
Organization Name:GENESIS HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-860-2621
Mailing Address - Street 1:PO BOX 22910
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-0910
Mailing Address - Country:US
Mailing Address - Phone:206-860-2621
Mailing Address - Fax:206-323-5247
Practice Address - Street 1:621 34TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-0910
Practice Address - Country:US
Practice Address - Phone:206-860-2621
Practice Address - Fax:206-323-5247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1992023OtherSUBSTANCE ABUSE