GENESIS RECOVERY, INC. (NPI# 1538511605) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538511605 |
| Entity Type | Organization |
| Organization Name | GENESIS RECOVERY, INC. |
| Other Organization Name | GENESIS RECOVERY SAN DIEGO |
| Practice Address |
7373 University Ave Suite 110 La Mesa CA 91942-0500 |
| Mailing Address |
7373 University Ave Suite 110, 111, 113 La Mesa CA 91942-0500 |
| Practice Telephone | 6197977319 |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2016-07-12 |
| Authorized Official Name | TOMMY HATHORN (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 8587174322 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Genesis Recovery San Diego | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831585561 | Genesis Recovery, Inc. | Substance Abuse Rehabilitation Facility | 24352 Featherstone Canyon Rd., Lakeside, CA 92040 | 2015-04-09 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | GENESIS RECOVERY, INC. | 7373 University Ave Ste 113, La Mesa, CA 91942-0523 |
| Street Address |
7373 UNIVERSITY AVE SUITE 110 |
| City | LA MESA |
| State | CA |
| Zip Code | 91942-0500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306186549 | David Ryan Allen | Behavioral Analyst | 7373 University Ave, Suite #114, La Mesa, CA 91942-0500 | 2013-02-26 |
| 1225483357 | Stepping Higher, Inc. | Case Management | 7373 University Ave, Suite 201, La Mesa, CA 91942-0500 | 2016-04-26 |
| 1225472772 | Letsgrow | Community/Behavioral Health | 7373 University Ave, 114, La Mesa, CA 91942-0500 | 2013-04-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902453723 | Nicole V Zappelli | Case Manager/Care Coordinator | 4990 William Ave., La Mesa, CA 91942 | 2019-08-26 |
| 1770059834 | Natalie Ngoc Nguyen | Physician Assistant | 5555 Grosmont Center Dr., La Mesa, CA 91942 | 2018-10-16 |
| 1194204297 | Courtney Pietsch | Nurse Practitioner | 8851 Health Center Circle, Suite #603, La Mesa, CA 91942 | 2018-08-09 |
| 1295214773 | Megan Gordon | Behavior Technician | 6116 Horton Dr, La Mesa, CA 91942 | 2018-08-07 |
| 1356836548 | Kimberly Denise Davis | Counselor | 3845 Avocado School Road, El Cajon, CA 91942 | 2018-06-29 |
| 1366932113 | Melanie Joyce Shepard | Physician Assistant | 7051 Alvarado Road, Suite 201, La Mesa, CA 91942 | 2018-05-17 |
| 1871013532 | Low Dental, A.p.c. | Public Health or Welfare | 7872 La Mesa Blvd., La Mesa, CA 91942 | 2017-06-23 |
| 1275069437 | Ardel Ayala | Respiratory Therapist, Registered | 5800 Lake Murray Blvd. Unit 15, La Mesa, CA 91942 | 2017-05-10 |
| 1285007583 | Counseling & Behavioral Specialists | Marriage & Family Therapist | 5520 Wellesley Street, Ste 204, La Mesa, CA 91942 | 2015-11-09 |
| 1285001875 | Emily Shozaki Rizo | Nurse Practitioner | 6285 Meadowcrest Drive, La Mesa, CA 91942 | 2015-08-31 |
| Find all providers in zip 91942 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518573526 | A Ka Center, LLC | Clinic/Center | 4715 Divine Way, La Mesa, CA 91941-6832 | 2020-09-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.