| Genesis Programs, Inc. | |
|
1732 Palma Dr Ste 208 Ventura CA 93003-5796 | |
| (805) 650-3094 | |
| (805) 650-3097 |
| Full Name | Genesis Programs, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1732 Palma Dr Ste 208, Ventura, California |
| Authorized Official Name and Position | Athena Naranjo (CEO/CLINICAL DIRECTOR) |
| Authorized Official Contact | 8056503094 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Programs, Inc. 1732 Palma Dr Ste 208 Ventura CA 93003-5796 Ph: (805) 650-3094 | Genesis Programs, Inc. 1732 Palma Dr Ste 208 Ventura CA 93003-5796 Ph: (805) 650-3094 |
| NPI Number | 1851510507 |
|---|---|
| Provider Enumeration Date | 04/24/2007 |
| Last Update Date | 01/26/2021 |
| Certification Date | 01/26/2021 |
| Medicare PECOS PAC ID | 1052650645 |
|---|---|
| Medicare Enrollment ID | O20190226001171 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851510507 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 560032AP (California) | Primary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Secondary |
| Provider Name | Ronald D Pollack |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790819175 PECOS PAC ID: 5092754531 Enrollment ID: I20050425001270 |
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