Provider Demographics
NPI:1437496809
Name:GENESISHEALTHCARENETWORK,INC.
Entity Type:Organization
Organization Name:GENESISHEALTHCARENETWORK,INC.
Other - Org Name:SERENITYSHORESRECOVERYCENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RHETT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-313-8246
Mailing Address - Street 1:1901 NEWPORT BLVD STE 280
Mailing Address - Street 2:SUITE 280
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2286
Mailing Address - Country:US
Mailing Address - Phone:714-313-8246
Mailing Address - Fax:
Practice Address - Street 1:1901 NEWPORT BLVD STE 280
Practice Address - Street 2:SUITE 280
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2286
Practice Address - Country:US
Practice Address - Phone:714-313-8246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-05
Last Update Date:2013-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility