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GENESIS DEVELOPMENTAL SERVICES
NPI 1023004561
Intermediate Care Facility, Intellectual Disabilities in San Lorenzo, CA

Active since September 20, 2005
17096 VIA FLORES, SAN LORENZO, CA 94580(510) 276-8442(510) 276-7802 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Genesis Developmental Services NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GENESIS DEVELOPMENTAL SERVICES (NPI 1023004561) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in San Lorenzo, California and active in the NPI registry since September 2005. The organization lists Pamela Graham, Controller, as its authorized official.

NPPES Registry Identity

NPI1023004561
Entity TypeOrganization
Primary Taxonomy315P00000X
Legal Business NameGENESIS CORPORATION
Location Address17096 VIA FLORESSan Lorenzo, CA 94580-2915
Mailing AddressPo Box 626Pismo Beach, CA 93448-0626 · (805) 489-9472 · Fax (805) 474-6893
Phone(510) 276-8442
Fax(510) 276-7802
Organization SubpartNo
Authorized OfficialPamela GrahamController · (805) 489-9472
Enumeration DateSeptember 20, 2005
Last NPPES UpdateAugust 22, 2020
✔ NPI 1023004561 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities
Taxonomy Code315P00000X
Definition
An intermediate care facility providing services for individuals with intellectual disabilities.
17096 VIA FLORES, San Lorenzo, CA 94580
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Other Names 1

Doing Business AsGenesis Developmental Services

Other Identifiers 1

MedicaidLTC60739FCA

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Genesis Corporation's NPI number?

The NPI number for Genesis Corporation is 1023004561. It was assigned to this organization in the NPPES registry on September 20, 2005. The provider is doing business as Genesis Developmental Services.

Where is Genesis Corporation located?

Genesis Corporation is located at 17096 Via Flores, San Lorenzo, CA 94580. The listed phone number is (510) 276-8442.

What is Genesis Corporation's specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

When was this NPI record last updated?

The NPPES record for Genesis Corporation was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.