Provider Demographics
NPI:1366982274
Name:GENESIS HOUSE, INC.
Entity type:Organization
Organization Name:GENESIS HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:717-232-6981
Mailing Address - Street 1:2 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17023-2026
Mailing Address - Country:US
Mailing Address - Phone:717-232-6981
Mailing Address - Fax:717-232-6980
Practice Address - Street 1:2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHVILLE
Practice Address - State:PA
Practice Address - Zip Code:17023-2026
Practice Address - Country:US
Practice Address - Phone:717-232-6981
Practice Address - Fax:717-232-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA227092101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty