Genesis Community Resource Center

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

GENESIS COMMUNITY RESOURCE CENTER

Doing business as

Genesis Home Health Care Services

Practice address

11616 Barberry CT
Saint John, IN 46373-9690

Phone

(708) 654-6324

NPI assigned

Mar 17, 2010

Last updated

Mar 17, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Shanda Rena Evans

Title

Administrator

Phone

(219) 884-1402

Specialties & licenses 1

Addresses

Other names 1

• Genesis Home Health Care Services Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268784000000",
    "number": "1013231117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 W RIDGE RD",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464082735",
            "telephone_number": "219-884-1402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11616 BARBERRY CT",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463739690",
            "telephone_number": "708-654-6324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS COMMUNITY RESOURCE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-17",
        "last_updated": "2010-03-17",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "SHANDA",
        "authorized_official_middle_name": "RENA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "219-884-1402",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Home Health Care Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephen Fugaj, D.D.S.
• Fuze Medical (FUZE Medical and Medispa)
• Aleksandar Galic, RPH
• Cynthia A Garza
• Genevieve Carlene Gehring-Gervase
• Genesis Rehab Services LLC (Genesis Rehab)
• Amelia Georgas, DO
• Jeanne Gindl-Mrzlock, R.N.
• Diana L Giordano
• Richard L Good, MD

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Saint John, IN
• Providers in Saint John, IN by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.