Provider Demographics
NPI:1063615417
Name:HASTON, GENARIS
Entity type:Individual
Prefix:MR
First Name:GENARIS
Middle Name:
Last Name:HASTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 221374
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33422-1374
Mailing Address - Country:US
Mailing Address - Phone:561-768-3600
Mailing Address - Fax:561-841-8237
Practice Address - Street 1:1213 ROSEGATE BLVD
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-1821
Practice Address - Country:US
Practice Address - Phone:561-844-2799
Practice Address - Fax:561-841-8237
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services