Provider Demographics
NPI:1477249779
Name:GENESIS COMMUNITY OUTREACH, TRAINING & EDUCATION
Entity Type:Organization
Organization Name:GENESIS COMMUNITY OUTREACH, TRAINING & EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:DELORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-203-6130
Mailing Address - Street 1:7565 E EAGLE CREST DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-1041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7565 E EAGLE CREST DR STE 100
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-1041
Practice Address - Country:US
Practice Address - Phone:480-203-6130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health