Organization
GENESIS THERAPEUTIC SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENDRICK ROGERS (PROGRAM DIRECTOR)
(910) 577-8200
Entity
Organization
Contact information
Practice address
99 VILLAGE DR STE 12, JACKSONVILLE, NC 28546-7060
(910) 577-8200
(910) 577-8270
Mailing address
99 VILLAGE DR STE 12, JACKSONVILLE, NC 28546-7060
(910) 577-8200
(910) 577-8270
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
MHL-067-165
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409583
—
NC
05
—
8300858
—
NC
05
—
8300858B
—
NC
05
—
8300858G
—
NC
05
—
8300859
—
NC
05
—
8300859B
—
NC
05
—
8300859G
—
NC
Enumeration date
02/28/2007
Last updated
08/22/2020
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