| Genesishouse, Inc. | |
|
549 Cox Rd Suite A Gastonia NC 28054-0628 | |
| (704) 852-3778 | |
| (704) 853-8751 |
| Full Name | Genesishouse, Inc. |
|---|---|
| Speciality | Case Management |
| Location | 549 Cox Rd, Gastonia, North Carolina |
| Authorized Official Name and Position | Kelvin Fernandez Hall (PRESIDENT) |
| Authorized Official Contact | 7048523778 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesishouse, Inc. Po Box 551389 Gastonia NC 28055-1389 Ph: (704) 852-3778 | Genesishouse, Inc. 549 Cox Rd Suite A Gastonia NC 28054-0628 Ph: (704) 852-3778 |
| NPI Number | 1093727893 |
|---|---|
| Provider Enumeration Date | 08/12/2006 |
| Last Update Date | 06/29/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093727893 | NPI | - | NPPES |
| 8300892 | Medicaid | NC | |
| 8300892B | Medicaid | NC | |
| 3418147 | Medicaid | NC | |
| 6102216 | Medicaid | NC | |
| 8303041R | Medicaid | NC | |
| 8303041 | Medicaid | NC | |
| 8300892V | Medicaid | NC | |
| 8300892G | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP0016X | Psychologist - Prescribing (medical) | 9401389 (North Carolina) | Secondary |
| 251B00000X | Case Management | (* (Not Available)) | Primary |
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