Provider Demographics
NPI:1295753895
Name:GENESIS RECOVERY SERVICES, INC.
Entity type:Organization
Organization Name:GENESIS RECOVERY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGVAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:907-243-5130
Mailing Address - Street 1:2825 W 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-2830
Mailing Address - Country:US
Mailing Address - Phone:907-243-5130
Mailing Address - Fax:907-248-8350
Practice Address - Street 1:2825 W 42ND AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-2830
Practice Address - Country:US
Practice Address - Phone:907-243-5130
Practice Address - Fax:907-248-8350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK297960324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK324500000XOtherSUBSTANCE ABUSE TREATMENT