Provider Demographics
NPI:1265994982
Name:GENESIS BEHAVIORAL SERVICES INCORPORATED
Entity type:Organization
Organization Name:GENESIS BEHAVIORAL SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOURICHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-273-7000
Mailing Address - Street 1:25701 N LAKELAND BLVD STE 403
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-2453
Mailing Address - Country:US
Mailing Address - Phone:216-273-7000
Mailing Address - Fax:216-273-7371
Practice Address - Street 1:25701 N LAKELAND BLVD STE 403
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-2453
Practice Address - Country:US
Practice Address - Phone:949-500-3155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0377389Medicaid