Provider Demographics
NPI:1881022622
Name:BRIGITTE GENO
Entity Type:Organization
Organization Name:BRIGITTE GENO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIGITTE
Authorized Official - Middle Name:U
Authorized Official - Last Name:GENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-419-1332
Mailing Address - Street 1:8365 N 56TH DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-6028
Mailing Address - Country:US
Mailing Address - Phone:602-419-1332
Mailing Address - Fax:
Practice Address - Street 1:8365 N 56TH DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-6028
Practice Address - Country:US
Practice Address - Phone:602-419-1332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-4392320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness