Organization
GENESIS YOUTH CRISIS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATT RUDDER (EXECUTIVE DIRECTOR)
(304) 622-1907
Entity
Organization
Contact information
Practice address
535 HORNER AVE, CLARKSBURG, WV 26301-3616
(304) 622-1907
(304) 623-9346
Mailing address
535 HORNER AVE, CLARKSBURG, WV 26301-3616
(304) 622-1907
(304) 623-9346
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0158712001
—
WV
Enumeration date
05/21/2007
Last updated
08/22/2020
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