Genesis Corporation

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

GENESIS CORPORATION

Doing business as

Genesis Developmental Services

Practice address

2225 Barrow St
San Leandro, CA 94577-3217

Phone

(510) 352-8537

Fax

(510) 352-8241

NPI assigned

Sep 20, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Pamela Graham

Title

Controller

Phone

(805) 489-9472

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• GENESIS DEVELOPMENTAL SERVICES Doing business as

Tax ID family

Genesis Corporation6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

• Genesis Corporation

  dba Genesis Developmental Services

  • Intellectual Disabilities Intermediate Care Facility
  • San Lorenzo, CA
  • NPI 1023004561
  NPD tax ID
• Genesis Corporation

  dba Genesis Developmental Services

  • Intellectual Disabilities Intermediate Care Facility
  • Santa Maria, CA
  • NPI 1043206576
  NPD tax ID
• Genesis Corporation

  dba Genesis Developmental Services

  • Intellectual Disabilities Intermediate Care Facility
  • Hayward, CA
  • NPI 1679569115
  NPD tax ID
• Genesis Corporation

  dba Genesis Developmental Services

  • Intellectual Disabilities Intermediate Care Facility
  • Hayward, CA
  • NPI 1750377297
  NPD tax ID
• Genesis Corporation

  dba Genesis Developmental Services

  • Intellectual Disabilities Intermediate Care Facility
  • Goleta, CA
  • NPI 1891781324
  NPD tax ID

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942296488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 626",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934480626",
            "telephone_number": "805-489-9472",
            "fax_number": "805-474-6893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2225 BARROW ST",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945773217",
            "telephone_number": "510-352-8537",
            "fax_number": "510-352-8241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "805-489-9472",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LTC80253F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GENESIS DEVELOPMENTAL SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Intellectual Disabilities Intermediate Care Facility in San Leandro, CA
• Providers in San Leandro, CA by specialty
• Intellectual Disabilities Intermediate Care Facility in California

• 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.