Organization
GENESIS HOUSE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELVIN HALL (PRESIDENT/CEO)
(704) 852-3778
Entity
Organization
Contact information
Practice address
549 COX RD, SUITE A, GASTONIA, NC 28054-0628
(704) 852-3778
Mailing address
PO BOX 551389, GASTONIA, NC 28055-1389
(704) 852-3778
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103TP0016X
Prescribing (Medical) Psychologist
—
—
251B00000X
Case Management Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5914113
—
NC
05
—
6002315
—
NC
05
—
6005952
—
NC
05
—
8300892G
—
NC
05
—
8300892H
—
NC
05
—
8300892V
—
NC
05
—
8302550
—
NC
05
—
8302550V
—
NC
05
—
8303041R
—
NC
05
—
8702052
—
NC
05
—
8703125
—
NC
05
—
8921979
—
NC
Enumeration date
12/30/2010
Last updated
04/11/2012
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