| Genesis House Bloomsburg | |
|
320 East Second Street Bloomsburg PA 17815 | |
| (570) 784-4073 | |
| (570) 704-4592 |
| Full Name | Genesis House Bloomsburg |
|---|---|
| Speciality | Clinic/center |
| Location | 320 East Second Street, Bloomsburg, Pennsylvania |
| Authorized Official Name and Position | James Robert Desanto (DIRECTOR OF OUTPATIENT SERVICES CCO) |
| Authorized Official Contact | 3703220520 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis House Bloomsburg 320 East Second Street Bloomsburg PA 17815 Ph: (570) 784-4073 | Genesis House Bloomsburg 320 East Second Street Bloomsburg PA 17815 Ph: (570) 784-4073 |
| NPI Number | 1518124783 |
|---|---|
| Provider Enumeration Date | 05/16/2008 |
| Last Update Date | 05/16/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518124783 | NPI | - | NPPES |
| 1007283800 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 197052 (Pennsylvania) | Primary |
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