Provider Demographics
NPI:1528419793
Name:THE GENESIS JOURNEY
Entity Type:Organization
Organization Name:THE GENESIS JOURNEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-288-3802
Mailing Address - Street 1:3384 DAYSTAR RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29720-9396
Mailing Address - Country:US
Mailing Address - Phone:803-288-3802
Mailing Address - Fax:
Practice Address - Street 1:3384 DAYSTAR RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-9396
Practice Address - Country:US
Practice Address - Phone:803-288-3802
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health