Provider Demographics
NPI:1164806220
Name:GENYSIS RESTORATION, INCORPORATED
Entity Type:Organization
Organization Name:GENYSIS RESTORATION, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:MIDDLEBROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MA,PC
Authorized Official - Phone:216-299-8789
Mailing Address - Street 1:27801 EUCLID AVE
Mailing Address - Street 2:454
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3549
Mailing Address - Country:US
Mailing Address - Phone:216-299-8789
Mailing Address - Fax:866-926-3348
Practice Address - Street 1:27801 EUCLID AVE
Practice Address - Street 2:454
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3549
Practice Address - Country:US
Practice Address - Phone:216-299-8789
Practice Address - Fax:866-926-3348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1867480251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable