Organization
GENESIS REVITALIZATION GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRANK MCCOY GILLIAM JR. PHD (REGINAL ADMINISTRATOR)
(609) 892-7681
Entity
Organization
Contact information
Practice address
16 S RHODE ISLAND AVE, ATLANTIC CITY, NJ 08401-7759
(609) 335-7373
Mailing address
16 S RHODE ISLAND AVE, ATLANTIC CITY, NJ 08401-7759
(609) 335-7373
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
01/05/2026
Last updated
01/09/2026
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