| Genesi Llc | |
|
626 N Broadway St Moore OK 73160-4814 | |
| (405) 626-1711 | |
| (405) 895-7544 |
| Full Name | Genesi Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 626 N Broadway St, Moore, Oklahoma |
| Authorized Official Name and Position | Rosanne Jill Nardoni Isom (CEO/LPC) |
| Authorized Official Contact | 4056262544 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesi Llc 626 N Broadway St Moore OK 73160-4814 Ph: (405) 626-1711 | Genesi Llc 626 N Broadway St Moore OK 73160-4814 Ph: (405) 626-1711 |
| NPI Number | 1669767257 |
|---|---|
| Provider Enumeration Date | 06/13/2011 |
| Last Update Date | 06/13/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669767257 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Oklahoma) | Primary |
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