Genesis DTC, LLC

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

Legal business name

GENESIS DTC, LLC

Practice address

350 Sycamore Rd
Genoa, IL 60135-1361

Phone

(815) 784-5146

Fax

(815) 784-4673

NPI assigned

Aug 10, 2015

Last updated

Aug 10, 2015By 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

Desiree A Johnson

Title

Executive Director

Phone

(815) 784-5146

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1439164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439164800000",
    "number": "1942686258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 SYCAMORE RD",
            "city": "GENOA",
            "state": "IL",
            "postal_code": "601351361",
            "telephone_number": "815-784-5146",
            "fax_number": "815-784-4673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 SYCAMORE RD",
            "city": "GENOA",
            "state": "IL",
            "postal_code": "601351361",
            "telephone_number": "815-784-5146",
            "fax_number": "815-784-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS DTC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-10",
        "last_updated": "2015-08-10",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DESIREE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "815-784-5146"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven J Disanti, DO
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• Justin Tyler Durancik, DDS
• Joshua Benjamin Eriks, DPT
• Family First Physicians SC
• Genesis Enterprises Inc
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• Genoa-Kingston Fire Protection District
• Umesh P Goswami, MD
• His Glory Transport LLC

• Developmentally Disabled Services Day Training Agency in Genoa, IL
• Providers in Genoa, IL by specialty
• Developmentally Disabled Services Day Training Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2015; 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.