Provider Demographics
NPI:1891587317
Name:GENESIS LEARNING AND OUTREACH CENTER INC.
Entity type:Organization
Organization Name:GENESIS LEARNING AND OUTREACH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-470-5610
Mailing Address - Street 1:1001 BISHOP ST STE 2685A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-3404
Mailing Address - Country:US
Mailing Address - Phone:808-470-5610
Mailing Address - Fax:
Practice Address - Street 1:961 ROBELLO LN
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4546
Practice Address - Country:US
Practice Address - Phone:808-470-5610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health