Provider Demographics
NPI:1366844524
Name:GENESIS CASE MANAGEMENT SERVICES, CORP
Entity Type:Organization
Organization Name:GENESIS CASE MANAGEMENT SERVICES, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRACERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-639-9639
Mailing Address - Street 1:8181 NW 36TH ST
Mailing Address - Street 2:SUITE 24
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6671
Mailing Address - Country:US
Mailing Address - Phone:305-639-9639
Mailing Address - Fax:305-381-0735
Practice Address - Street 1:8181 NW 36TH ST
Practice Address - Street 2:SUITE 24
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6671
Practice Address - Country:US
Practice Address - Phone:305-639-9639
Practice Address - Fax:305-381-0735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL012187400Medicaid