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Genesis Project 1 — NPI 1417364480, Charlotte, NC | NPI Central

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OrganizationActive

Genesis Project 1

NPI 1417364480 · Point of Service · Charlotte, NC

Provider details

NPI number: 1417364480
Entity type: Organization
Primary specialty: Point of ServiceManaged Care Organizations
Authorized official: Trasha Black, Clinical Director
License: P009049 (NC)

Practice location

5108 Reagan Dr

Suite 14

Charlotte, NC 28206-3103

Phone: (704) 596-0505

Fax: (704) 596-0507

More NC providers

Mailing address

5108 Reagan Dr

Charlotte, NC 28206-3103

Registry dates

Enumerated: 2014-07-22
Last updated: 2014-07-22

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.