Provider Demographics
NPI:1487815510
Name:GENESIS FAMILY CENTER
Entity Type:Organization
Organization Name:GENESIS FAMILY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR
Authorized Official - Prefix:
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
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:559-226-2837
Practice Address - Street 1:37180 JOSE BASIN RD
Practice Address - Street 2:
Practice Address - City:AUBERRY
Practice Address - State:CA
Practice Address - Zip Code:93602
Practice Address - Country:US
Practice Address - Phone:559-439-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health