Organization
GENESIS CORPORATION
Active
Other names
GENESIS DEVELOPMENTAL SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PAMELA GRAHAM (CONTROLLER)
(805) 489-9472
Entity
Organization
Contact information
Practice address
3336 BRIDLE DR, HAYWARD, CA 94541-5706
(510) 582-2873
(510) 582-4463
Mailing address
PO BOX 626, PISMO BEACH, CA 93448-0626
(805) 489-9472
(805) 474-6893
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LTC80260F
—
CA
Enumeration date
09/20/2005
Last updated
08/22/2020
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