Active NPI
Genesis Youth & Family Services, LLC
- Community/Behavioral Health Agency
- Charlotte, NC
National Provider Identifier
1497908693
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Legal business name
- GENESIS YOUTH & FAMILY SERVICES, LLC
- Practice address
- 9700 Research Dr
Suite 122
Charlotte, NC 28262-8552 - Phone
- (704) 940-0036
- Fax
- (704) 598-2632
- NPI assigned
- Oct 31, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Teresa Jackson
- Title
- Ceo/Owner
- Phone
- (704) 940-0036
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Management Agency | 251B00000X | |||
| Community/Behavioral Health Agency | 251S00000X | Primary |
Addresses
Primary practice location
9700 Research Dr
Suite 122
Charlotte, NC 28262-8552
Mailing address
9700 Research Dr
Suite 122
Charlotte, NC 28262-8552
Phone (704) 940-0036
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6006860 | Medicaid | NC | |
| 8302598B | Medicaid | NC | |
| 8302598H | Medicaid | NC | |
| 8302598 | Medicaid | NC |
National Provider Directory
National Provider Directory- Tax ID family
- Genesis Youth Family Services LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Professional Counselor
- Charlotte, NC
- NPI 1760717656
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1225411200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1279152000000",
"number": "1497908693",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9700 RESEARCH DR",
"address_2": "SUITE 122",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282628552",
"telephone_number": "704-940-0036",
"fax_number": "704-598-2632"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9700 RESEARCH DR",
"address_2": "SUITE 122",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282628552",
"telephone_number": "704-940-0036",
"fax_number": "704-598-2632"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GENESIS YOUTH & FAMILY SERVICES, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-10-31",
"last_updated": "2010-07-15",
"status": "A",
"authorized_official_last_name": "JACKSON",
"authorized_official_first_name": "TERESA",
"authorized_official_title_or_position": "CEO/OWNER",
"authorized_official_telephone_number": "704-940-0036"
},
"taxonomies": [
{
"code": "251B00000X",
"taxonomy_group": "",
"desc": "Case Management",
"state": null,
"license": null,
"primary": false
},
{
"code": "251S00000X",
"taxonomy_group": "",
"desc": "Community/Behavioral Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6006860",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8302598B",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8302598H",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8302598",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.