Organization
GENESIS COMMUNITY RESOURCE CENTER
Active
Other names
Genesis Home Health Care Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANDA RENA EVANS (ADMINISTRATOR)
(219) 884-1402
Entity
Organization
Contact information
Practice address
11616 BARBERRY CT, SAINT JOHN, IN 46373-9690
(708) 654-6324
Mailing address
320 W RIDGE RD, GARY, IN 46408-2735
(219) 884-1402
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/17/2010
Last updated
03/17/2010
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