Provider Demographics
NPI:1366980930
Name:NEW GENESIS LLC
Entity type:Organization
Organization Name:NEW GENESIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUWOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOLAOSO
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT/CEO
Authorized Official - Phone:720-339-3542
Mailing Address - Street 1:21352 E 50TH PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80249-8237
Mailing Address - Country:US
Mailing Address - Phone:720-339-3542
Mailing Address - Fax:
Practice Address - Street 1:21352 E 50TH PL
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-8237
Practice Address - Country:US
Practice Address - Phone:720-339-3542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services