Provider Demographics
NPI:1982326898
Name:GENESIS ADULT ACTIVITY CENTER
Entity Type:Organization
Organization Name:GENESIS ADULT ACTIVITY CENTER
Other - Org Name:GENESIS ADULT ACTIVITY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:CORTEZ
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-368-3057
Mailing Address - Street 1:930 MURPHY RD STE B
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5976
Mailing Address - Country:US
Mailing Address - Phone:832-368-3057
Mailing Address - Fax:281-969-7776
Practice Address - Street 1:930 MURPHY RD STE B
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5976
Practice Address - Country:US
Practice Address - Phone:183-236-8305
Practice Address - Fax:281-969-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services