NPIMap

Organization Active NPI

Genesis Youth Crisis Center

  • Community/Behavioral Health Agency
  • Clarksburg, WV
National Provider Identifier
1821206715
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
GENESIS YOUTH CRISIS CENTER
Practice address
535 Horner Ave
Clarksburg, WV 26301-3616
Phone
(304) 622-1907
Fax
(304) 623-9346
NPI assigned
May 21, 2007
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. Matt Rudder
Title
Executive Director
Phone
(304) 622-1907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

535 Horner Ave
Clarksburg, WV 26301-3616

Mailing address

535 Horner Ave
Clarksburg, WV 26301-3616
Phone (304) 622-1907

Other identifiers 1

IdentifierTypeStateIssuer
0158712001MedicaidWV

National Provider Directory

National Provider Directory
Tax ID family
Genesis Youth Crisis Center Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

535 Hornor Ave
Clarksburg, WV 26301
Phone (304) 622-1907

NPI Registry JSON

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

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821206715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 HORNER AVE",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263013616",
            "telephone_number": "304-622-1907",
            "fax_number": "304-623-9346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 HORNER AVE",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263013616",
            "telephone_number": "304-622-1907",
            "fax_number": "304-623-9346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS YOUTH CRISIS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RUDDER",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "304-622-1907",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0158712001",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksburg, WV

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.