Organization
GENESIS FAMILY HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN KENNEDY EDMOND (EXECUTIVE DIRECTOR OWNER)
(704) 793-9593
Entity
Organization
Contact information
Practice address
1036 BRANCHVIEW DR, SUITE 201, CONCORD, NC 28025-2998
(704) 793-9593
Mailing address
1036 BRANCHVIEW DR, SUITE 201, CONCORD, NC 28025-2998
(704) 793-9593
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/01/2007
Last updated
08/22/2020
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