| Genesis House Inc | |
|
800 W Fourth Street Suite G01 Williamsport PA 17701 | |
| (570) 322-0520 | |
| (570) 326-9674 |
| Full Name | Genesis House Inc |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 800 W Fourth Street, Williamsport, Pennsylvania |
| Authorized Official Name and Position | James R De Santo (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5703220520 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis House Inc 800 W Fourth Street Suite G01 Williamsport PA 17701 Ph: (570) 322-0520 | Genesis House Inc 800 W Fourth Street Suite G01 Williamsport PA 17701 Ph: (570) 322-0520 |
| NPI Number | 1801995832 |
|---|---|
| Provider Enumeration Date | 09/22/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801995832 | NPI | - | NPPES |
| 1007283800008 | Medicaid | PA | |
| 807234 | Other | PA | FPH NE PA |
| 999036 | Other | PA | BC NE PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 417015 (Pennsylvania) | Primary |
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