National Provider Identifier Database

GENESIS
Residential Treatment Facility, Physical Disabilities

A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with physical disabilities and are not able to live independently.


Contact Information

GENESIS
17110 E 51ST ST
BROKEN ARROW, OK74012-9279
Phone: 918-851-0737
Fax:
Website:
Specialty Taxonomy Code
* Residential Treatment Facility, Physical Disabilities 320700000X
Nursing Facility/Intermediate Care Facility 313M00000X
Residential Treatment Facility, Intellectual and/or Developmental Disabilities 320600000X

* Indicates primary specialty

NPI Profile & details for GENESIS

NPI Number 1306250675
Legal business name
LBN
GENESIS
Authorized official JOELLA ESCOE - (OCCUPATIONAL THERAPY)
Entity Organization
Organization subpart No
Enumeration date 06/16/2014
Last updated 06/16/2014 - About 12 years ago
Sole proprietor1 Not specified
Identifiers
  • OK License #: 280
  • OK License #: OA280

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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