Organization
GENESIS LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RITA AGHENTA (ADMINISTRATOR)
(651) 955-6535
Entity
Organization
Contact information
Practice address
2839 E COURTNEY ST, GILBERT, AZ 85298-5735
(651) 955-6535
Mailing address
2839 E COURTNEY ST, GILBERT, AZ 85298-5735
(651) 955-6535
Taxonomy
Speciality
Code
Description
License number
State
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
BH5499
AZ
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
08/27/2018
Last updated
06/28/2021
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