Provider Demographics
NPI:1760358303
Name:GENESIS ADULT EDUCATION ACADEMY
Entity type:Organization
Organization Name:GENESIS ADULT EDUCATION ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:VELORA
Authorized Official - Last Name:SCREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:863-934-4375
Mailing Address - Street 1:220 S CENTRAL AVE UNIT 982
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33831-7041
Mailing Address - Country:US
Mailing Address - Phone:863-934-4375
Mailing Address - Fax:863-934-4375
Practice Address - Street 1:220 S CENTRAL AVE UNIT 982
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33831-7041
Practice Address - Country:US
Practice Address - Phone:863-934-4375
Practice Address - Fax:863-934-4375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)