Provider Demographics
NPI:1164012373
Name:GENESIS BEHAVIORAL SERVICES, INC
Entity Type:Organization
Organization Name:GENESIS BEHAVIORAL SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-301-6381
Mailing Address - Street 1:2819 W HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-3217
Mailing Address - Country:US
Mailing Address - Phone:414-939-7145
Mailing Address - Fax:414-321-5935
Practice Address - Street 1:4107 SAINT CLAIR ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-3007
Practice Address - Country:US
Practice Address - Phone:414-939-7145
Practice Address - Fax:414-321-5935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health