Organization
FIRST GENESIS GROUP HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAN CHAMBERS (EXECUTIVE DIRECTOR)
(336) 274-4447
Entity
Organization
Contact information
Practice address
1903 DELMAR DR, GREENSBORO, NC 27406-6113
(336) 274-4447
(336) 852-6400
Mailing address
1903 DELMAR DR, GREENSBORO, NC 27406-6113
(336) 274-4447
(336) 323-0062
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-041-728
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603817
—
NC
Enumeration date
10/04/2006
Last updated
06/09/2009
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