Provider Demographics
NPI:1295028272
Name:THE GENESIS CENTER
Entity Type:Organization
Organization Name:THE GENESIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:PHEAMO
Authorized Official - Middle Name:R
Authorized Official - Last Name:WITCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MCP
Authorized Official - Phone:401-781-6110
Mailing Address - Street 1:620 POTTERS AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-2931
Mailing Address - Country:US
Mailing Address - Phone:401-781-6110
Mailing Address - Fax:401-461-8788
Practice Address - Street 1:620 POTTERS AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-2931
Practice Address - Country:US
Practice Address - Phone:401-781-6110
Practice Address - Fax:401-461-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health