Provider Demographics
NPI:1336498013
Name:GENESYS HILLSIDE BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:GENESYS HILLSIDE BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PURNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SURAPANENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-424-2400
Mailing Address - Street 1:4396 MEADOWS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8689
Mailing Address - Country:US
Mailing Address - Phone:810-424-2400
Mailing Address - Fax:810-579-7222
Practice Address - Street 1:4396 MEADOWS AVE
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8689
Practice Address - Country:US
Practice Address - Phone:810-513-2390
Practice Address - Fax:810-579-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801081184283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital