First Genesis Group Home Inc

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

License

MHL-041-728 Issued in NC

Legal business name

FIRST GENESIS GROUP HOME INC

Practice address

1903 Delmar Dr
Greensboro, NC 27406-6113

Phone

(336) 274-4447

Fax

(336) 852-6400

NPI assigned

Oct 4, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Jan Chambers

Title

Executive Director

Phone

(336) 274-4447

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244505600000",
    "number": "1346335288",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1903 DELMAR DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274066113",
            "telephone_number": "336-274-4447",
            "fax_number": "336-323-0062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1903 DELMAR DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274066113",
            "telephone_number": "336-274-4447",
            "fax_number": "336-852-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST GENESIS GROUP HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2009-06-09",
        "status": "A",
        "authorized_official_last_name": "CHAMBERS",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "336-274-4447",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-041-728",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603817",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alicia Claire Firestone, MD
• First Alternatives Inc
• First Class Wellness LLC
• First Genesis Family Services Inc
• First Genesis Group Home (Dba) Bisbee Place
• First One Choice Home Care Agency
• Gary Jay Fischer, MD
• Fisher Park Counseling
• Beth Fisher
• David Monroe Fisher Jr., DDS

• Emotionally Disturbed Childrens' Residential Treatment Facility in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2009; 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.