Provider Demographics
NPI:1275705030
Name:GENESIS SUPPORT COORDINATION CO
Entity Type:Organization
Organization Name:GENESIS SUPPORT COORDINATION CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PINTADO
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:305-447-1200
Mailing Address - Street 1:411 ALHAMBRA CIR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4901
Mailing Address - Country:US
Mailing Address - Phone:305-447-1200
Mailing Address - Fax:
Practice Address - Street 1:411 ALHAMBRA CIR
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4901
Practice Address - Country:US
Practice Address - Phone:305-447-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL677959098Medicaid
FL677959068Medicaid
FL677959096Medicaid