Organization
GENESIS CLUB HOUSE, INC.
Active
Other names
Genesis Club, Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEVIN L BRADLEY M ED (EXECUTIVE DIRECTOR)
(508) 831-0100
Entity
Organization
Contact information
Practice address
274 LINCOLN ST, WORCESTER, MA 01605-2106
(508) 831-0100
(508) 753-1286
Mailing address
274 LINCOLN ST, WORCESTER, MA 01605-2106
(508) 831-0100
(508) 753-1286
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/04/2014
Last updated
06/20/2018
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