| Genesis Behavioral Services Incorporated | |
|
25701 N Lakeland Blvd Ste 403 Euclid OH 44132-2453 | |
| (949) 500-3155 | |
| Not Available |
| Full Name | Genesis Behavioral Services Incorporated |
|---|---|
| Speciality | Counselor |
| Location | 25701 N Lakeland Blvd Ste 403, Euclid, Ohio |
| Authorized Official Name and Position | Nabil Abouriche (PRESIDENT) |
| Authorized Official Contact | 2162737000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Behavioral Services Incorporated 25701 N Lakeland Blvd Ste 403 Euclid OH 44132-2453 Ph: (216) 273-7000 | Genesis Behavioral Services Incorporated 25701 N Lakeland Blvd Ste 403 Euclid OH 44132-2453 Ph: (949) 500-3155 |
| NPI Number | 1265994982 |
|---|---|
| Provider Enumeration Date | 04/02/2019 |
| Last Update Date | 07/27/2021 |
| Certification Date | 07/27/2021 |
| Medicare PECOS PAC ID | 4183006570 |
|---|---|
| Medicare Enrollment ID | O20220802000683 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265994982 | NPI | - | NPPES |
| 0377389 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Joy A Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1235428780 PECOS PAC ID: 5991937179 Enrollment ID: I20140423000539 |
| Provider Name | Rodney L Long |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1396109401 PECOS PAC ID: 9335543412 Enrollment ID: I20210811003260 |
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