1801088604 NPI number — GENESIS COUNSELING CENTER, INC.

Table of content: BARAKAT KH. M.B ABURAJAB ALTAMIMI M.D. (NPI 1225444862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801088604 NPI number — GENESIS COUNSELING CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS COUNSELING CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801088604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 901402
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44190-1402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17747 CHILLICOTHE RD
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
CHAGRIN FALLS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44023-4739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-543-8880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FIKTER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
440-543-8880

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  35.063299 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000136790 . This is a "ANTHEM BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 191762 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0147004 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5781747 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".