Provider Demographics
NPI:1942625082
Name:GENESIS RECOVERY SERVICES, LLC
Entity Type:Organization
Organization Name:GENESIS RECOVERY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/TREATMENT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JARVE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW,LICSW,LADC
Authorized Official - Phone:218-591-4289
Mailing Address - Street 1:402 HEATHER AVE
Mailing Address - Street 2:
Mailing Address - City:CLOQUET
Mailing Address - State:MN
Mailing Address - Zip Code:55720-3019
Mailing Address - Country:US
Mailing Address - Phone:218-591-4289
Mailing Address - Fax:218-879-2050
Practice Address - Street 1:5 N 3RD AVE W
Practice Address - Street 2:SUITE 310
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1614
Practice Address - Country:US
Practice Address - Phone:218-591-4289
Practice Address - Fax:218-879-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health