Provider Demographics
NPI:1164871364
Name:GENYSIS RESTORATION, INC.
Entity Type:Organization
Organization Name:GENYSIS RESTORATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PASTORAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:MIDDLEBROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:MAPC
Authorized Official - Phone:216-299-8789
Mailing Address - Street 1:27801 EUCLID AVENUE
Mailing Address - Street 2:SUITE 458
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132
Mailing Address - Country:US
Mailing Address - Phone:216-299-8789
Mailing Address - Fax:
Practice Address - Street 1:27801 EUCLID AVE
Practice Address - Street 2:SUITE 458
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health