Organization
GENESIS OUTPATIENT LLC
Active
Other names
GENESIS OUT PATIENT
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD GATONGA (OWNER)
(954) 865-9794
Entity
Organization
Contact information
Practice address
7303 E MAIN ST STE 106, MESA, AZ 85207-8325
(954) 865-9794
Mailing address
7303 E MAIN ST STE 106, MESA, AZ 85207-8325
(954) 865-9794
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
09/13/2023
Last updated
09/18/2024
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