Provider Demographics
NPI:1568681229
Name:GENESIS PROGRAMS, INC.
Entity Type:Organization
Organization Name:GENESIS PROGRAMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:
Authorized Official - Last Name:NARANJO
Authorized Official - Suffix:
Authorized Official - Credentials:LAADC
Authorized Official - Phone:805-650-3094
Mailing Address - Street 1:1732 PALMA DR.
Mailing Address - Street 2:SUITE 208
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5796
Mailing Address - Country:US
Mailing Address - Phone:805-650-3094
Mailing Address - Fax:805-650-3094
Practice Address - Street 1:145 HODENCAMP RD
Practice Address - Street 2:SUITE 207
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5810
Practice Address - Country:US
Practice Address - Phone:805-497-6169
Practice Address - Fax:805-497-6179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA560032BP251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health