Organization
GENESIS YOUTH CRISIS CENTER INC
Active
Other names
Genesis Family Development Services
Organization subpart
No
Provider details
NPI number
Authorized official
MATT RUDDER MBA (CHIEF EXECUTIVE OFFICER)
(304) 622-1907
Entity
Organization
Contact information
Practice address
192 SAFE HAVEN DR, CLARKSBURG, WV 26301-9103
(304) 622-1907
(304) 623-9346
Mailing address
PO BOX 546, CLARKSBURG, WV 26302-0546
(304) 622-1907
(304) 623-9346
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
13GR20
WV
Other
Enumeration date
08/19/2015
Last updated
08/19/2015
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