NPIMap

Organization Active NPI

Genesis Family Home

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Concord, NC
National Provider Identifier
1629299532
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
Legal business name
GENESIS FAMILY HOME
Practice address
1036 Branchview Dr
Suite 201
Concord, NC 28025-2998
Phone
(704) 793-9593
NPI assigned
May 1, 2007
Last updated
Aug 22, 2020By the provider in NPPES
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
Mr. John Kennedy EdmondNPI 1821146986
Title
Executive Director Owner
Phone
(704) 793-9593

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X Primary

Addresses

Primary practice location

1036 Branchview Dr
Suite 201
Concord, NC 28025-2998

Mailing address

1036 Branchview Dr
Suite 201
Concord, NC 28025-2998
Phone (704) 793-9593

National Provider Directory

National Provider Directory
Tax ID family
Genesis Family Home4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1036 Branchview Dr
Ste 201
Concord, NC 28025
Phone (704) 659-3541

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1629299532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1036 BRANCHVIEW DR",
            "address_2": "SUITE 201",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252998",
            "telephone_number": "704-793-9593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1036 BRANCHVIEW DR",
            "address_2": "SUITE 201",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280252998",
            "telephone_number": "704-793-9593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS FAMILY HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EDMOND",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "KENNEDY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR OWNER",
        "authorized_official_telephone_number": "704-793-9593",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

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.