NPIMap

Organization Active NPI

Genesis Family Home

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Concord, NC
National Provider Identifier
1649495243
Registry record updated Jul 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
MHL-013-060 Issued in NC
Legal business name
GENESIS FAMILY HOME
Practice address
514 Todd Dr NE
Concord, NC 28025-3135
Phone
(704) 793-9593
NPI assigned
Apr 17, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2008

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

Authorized official

Name
Mr. John Kennedy Edmond Sr.
Title
Executive Director
Phone
(704) 793-9593

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X MHL-013-060 NC Primary

Addresses

Primary practice location

514 Todd Dr NE
Concord, NC 28025-3135

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
6603176MedicaidNC

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.

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217376000000",
    "number": "1649495243",
    "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": "514 TODD DR NE",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280253135",
            "telephone_number": "704-793-9593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS FAMILY HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2008-07-30",
        "status": "A",
        "authorized_official_last_name": "EDMOND",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "KENNEDY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "704-793-9593",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NC",
            "license": "MHL-013-060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603176",
            "state": "NC"
        }
    ],
    "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 Jul 30, 2008; 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.