Provider Demographics
NPI:1386815520
Name:GENESIS FAMILY CENTER
Entity Type:Organization
Organization Name:GENESIS FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:DELA TORRE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:559-439-5437
Mailing Address - Street 1:7475 N PALM AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-5763
Mailing Address - Country:US
Mailing Address - Phone:559-439-5437
Mailing Address - Fax:559-439-5411
Practice Address - Street 1:2920 E OLIVE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-1223
Practice Address - Country:US
Practice Address - Phone:559-439-5437
Practice Address - Fax:559-439-5411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-16
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health