Provider Demographics
NPI:1679930655
Name:GENESEE COMMUNITY SERVICES, LLC
Entity Type:Organization
Organization Name:GENESEE COMMUNITY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASCHKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-569-5510
Mailing Address - Street 1:36100 GENESEE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-9201
Mailing Address - Country:US
Mailing Address - Phone:262-569-5510
Mailing Address - Fax:262-569-5513
Practice Address - Street 1:36100 GENESEE LAKE RD
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-9201
Practice Address - Country:US
Practice Address - Phone:262-569-5510
Practice Address - Fax:262-569-5513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health