# FIRST GENESIS GROUP HOME INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1346335288
- **Authorized official:** DR. JAN CHAMBERS (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (336) 274-4447

## Contact information

- **Practice address:** 1903 DELMAR DR, GREENSBORO, NC 27406-6113
- **Practice address phone:** (336) 274-4447
- **Practice address fax:** (336) 852-6400
- **Mailing address:** 1903 DELMAR DR, GREENSBORO, NC 27406-6113
- **Mailing address phone:** (336) 274-4447
- **Mailing address fax:** (336) 323-0062

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | MHL-041-728 | NC | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 06/09/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6603817 | — | NC |