Organization
GENESIS RESIDENTIAL CARE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VIVIAN HAITH TIMMONS (CEO)
(336) 512-2114
Entity
Organization
Contact information
Practice address
236 N MEBANE ST, BURLINGTON, NC 27217-3966
(336) 512-2114
Mailing address
PO BOX 1966, BURLINGTON, NC 27216-1966
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-001-148
NC
Other
Enumeration date
09/19/2013
Last updated
09/19/2013
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