Provider Demographics
NPI:1780913970
Name:FIRST GENESIS FAMILY SERVICES INC
Entity type:Organization
Organization Name:FIRST GENESIS FAMILY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:WILLETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-292-1555
Mailing Address - Street 1:1903 DELMAR DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27406-6113
Mailing Address - Country:US
Mailing Address - Phone:336-292-1555
Mailing Address - Fax:
Practice Address - Street 1:4821 BISBEE DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-9710
Practice Address - Country:US
Practice Address - Phone:336-292-1555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-041-728322D00000X, 323P00000X
NCMHL-041-837323P00000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility