Organization
GENESIS AT HOME LLC
Active
Other names
Genesis At Home
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY AGHENTA (PRESIDENT)
(651) 246-7242
Entity
Organization
Contact information
Practice address
1027 W CALYPSO CT, GILBERT, AZ 85233-6769
(651) 246-7242
Mailing address
1027 W CALYPSO CT, GILBERT, AZ 85233-6769
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/11/2020
Last updated
09/11/2020
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