Provider Demographics
NPI:1316116809
Name:GENESIS HOUSE READING
Entity type:Organization
Organization Name:GENESIS HOUSE READING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OUTPATIENT SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:DESANTO
Authorized Official - Suffix:
Authorized Official - Credentials:LSW CCDP D
Authorized Official - Phone:570-322-0520
Mailing Address - Street 1:697 READING AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611
Mailing Address - Country:US
Mailing Address - Phone:610-372-5741
Mailing Address - Fax:610-372-5849
Practice Address - Street 1:697 READING AVENUE
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611
Practice Address - Country:US
Practice Address - Phone:610-372-5741
Practice Address - Fax:610-372-5849
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS HOUSE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007283800Medicaid