Genesis Club House, Inc.

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

GENESIS CLUB HOUSE, INC.

Practice address

274 Lincoln St
Worcester, MA 01605-2106

Phone

(508) 831-0100

Fax

(508) 753-1286

NPI assigned

Aug 4, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Kevin L Bradley, M ED

Title

Executive Director

Phone

(508) 831-0100

Specialties & licenses 1

Addresses

Other names 1

• Genesis Club, Inc. Other name

Locations

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

{
    "created_epoch": "1407110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1568871663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "274 LINCOLN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052106",
            "telephone_number": "508-831-0100",
            "fax_number": "508-753-1286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "274 LINCOLN ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016052106",
            "telephone_number": "508-831-0100",
            "fax_number": "508-753-1286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS CLUB HOUSE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-04",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "508-831-0100",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M ED"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Club, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sabrina Elizabeth Gemme, AU.D.
• Desiree Genard
• Jennifer Gendron
• Cara Elizabeth Genduso, MD
• Michael A Genese
• Christopher John Gengarelli, LMT
• Alexis Genna
• Brian A Genna I, DMD
• Gabriel M Gennari, LCSW
• Genoa Healthcare LLC

• Community/Behavioral Health Agency in Worcester, MA
• Providers in Worcester, MA by specialty
• Community/Behavioral Health Agency in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; 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.