NPIMap

Organization Active NPI

Genesis Corporation

  • Intellectual Disabilities Intermediate Care Facility
  • San Lorenzo, CA
National Provider Identifier
1023004561
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
GENESIS CORPORATION
Doing business as
GENESIS DEVELOPMENTAL SERVICES
Practice address
17096 Via Flores
San Lorenzo, CA 94580-2915
Phone
(510) 276-8442
Fax
(510) 276-7802
NPI assigned
Sep 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Ms. Pamela Graham
Title
Controller
Phone
(805) 489-9472

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X CA Primary

Addresses

Primary practice location

17096 Via Flores
San Lorenzo, CA 94580-2915

Mailing address

PO Box 626
Pismo Beach, CA 93448-0626
Phone (805) 489-9472

Other identifiers 1

IdentifierTypeStateIssuer
LTC60739FMedicaidCA

Other names 1

  • GENESIS DEVELOPMENTAL SERVICES Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Genesis Corporation6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1023004561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 626",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934480626",
            "telephone_number": "805-489-9472",
            "fax_number": "805-474-6893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17096 VIA FLORES",
            "city": "SAN LORENZO",
            "state": "CA",
            "postal_code": "945802915",
            "telephone_number": "510-276-8442",
            "fax_number": "510-276-7802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "805-489-9472",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC60739F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GENESIS DEVELOPMENTAL SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Lorenzo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.