Organization
GENESIS MANOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHRISTINA SMITH JACKSON (RECORDS MANAGER/COOWNER)
(434) 610-6132
Entity
Organization
Contact information
Practice address
1560 KNOTT ST, LYNCHBURG, VA 24502-5107
(434) 237-2044
(434) 237-2055
Mailing address
1560 KNOTT ST, LYNCHBURG, VA 24502-5107
(434) 237-2044
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
1751
VA
Other
Enumeration date
02/01/2012
Last updated
02/01/2012
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