Provider Demographics
NPI:1255081675
Name:GENESIS YOUTH CRISIS CENTER, INC.
Entity type:Organization
Organization Name:GENESIS YOUTH CRISIS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CQI SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:BA, LSW
Authorized Official - Phone:304-622-1907
Mailing Address - Street 1:192 SAFE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-9103
Mailing Address - Country:US
Mailing Address - Phone:304-622-1907
Mailing Address - Fax:304-623-9346
Practice Address - Street 1:591 PRESSLEY RIDGE RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-7024
Practice Address - Country:US
Practice Address - Phone:304-709-7020
Practice Address - Fax:681-399-9115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS YOUTH CRISIS CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health