Provider Demographics
NPI:1760811509
Name:GENESIS 1 THE HOUSE OF CARE
Entity Type:Organization
Organization Name:GENESIS 1 THE HOUSE OF CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALESIA
Authorized Official - Middle Name:ANITA
Authorized Official - Last Name:RAWLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-477-6882
Mailing Address - Street 1:314 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-1553
Mailing Address - Country:US
Mailing Address - Phone:757-562-5505
Mailing Address - Fax:757-562-5500
Practice Address - Street 1:314 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1553
Practice Address - Country:US
Practice Address - Phone:757-562-5505
Practice Address - Fax:757-562-5500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA130301001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities