Genesis Manor, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

1751 Issued in VA

Legal business name

GENESIS MANOR, LLC

Practice address

1560 Knott St
Lynchburg, VA 24502-5107

Phone

(434) 237-2044

Fax

(434) 237-2055

NPI assigned

Feb 1, 2012

Last updated

Feb 1, 2012By 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. Christina Smith Jackson

Title

Records Manager/Coowner

Phone

(434) 610-6132

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1328054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328054400000",
    "number": "1972875318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 KNOTT ST",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245025107",
            "telephone_number": "434-237-2044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 KNOTT ST",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245025107",
            "telephone_number": "434-237-2044",
            "fax_number": "434-237-2055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS MANOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-01",
        "last_updated": "2012-02-01",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_middle_name": "SMITH",
        "authorized_official_title_or_position": "RECORDS MANAGER/COOWNER",
        "authorized_official_telephone_number": "434-610-6132",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "VA",
            "license": "1751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Catie Elizabeth George
• Shawn M George, LPC
• Seth A Gerard, MD
• Nicole Gerlich

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Lynchburg, VA
• Providers in Lynchburg, VA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2012; 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.