| NPI | 1043411762 |
|---|---|
| Other Name | GENESIS METHADONE |
| Entity Type | Organization |
| Authorized Contact | RUBEN IMPERIAL Behavioral Health Interim Director 209-525-6225 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2020-02-24 |