Genesis Community Resource Center
NPI #1013231117 in Saint John, Indiana
Provider Information
- NPI Number
- 1013231117
- Entity Type
- Organization
- Organization Name
- Genesis Community Resource Center
- Primary Specialty
- Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
- Enumeration Date
- Mar 17, 2010
- Last Updated
- Mar 17, 2010
Practice Location
- Address
- 11616 BARBERRY CT
- City
- Saint John
- State
- Indiana
- ZIP Code
- 46373-9690
- Phone
- (708) 654-6324
Authorized Official
- Name
- DR. SHANDA RENA EVANS
- Title
- ADMINISTRATOR
- Phone
- (219) 884-1402
Specialties & Taxonomy Codes
| Specialty |
|---|
| Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
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