Organization
GENESIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA JOANNE HANNAH (PROVIDER)
(469) 835-6428
Entity
Organization
Contact information
Practice address
700 WALNUT RIDGE DR, 3055, IRVING, TX 75038-1000
(469) 835-6428
(972) 871-2740
Mailing address
700 WALNUT RIDGE DR, 3055, IRVING, TX 75038-1000
(469) 835-6428
(972) 871-2740
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
835552
TX
Other
Enumeration date
12/09/2008
Last updated
12/09/2008
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