MEDICARE: GENESIS THERAPEUTICAL SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1598135774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS THERAPEUTICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	5721 SW 13TH TERRACE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33144
Country	:	US
Telephone Number	:	786-312-4804
Fax Number	:

Provider Business Practice Location Address
First Line	:	5721 SW 13TH TER
Second Line	:
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-5705
Country	:	US
Telephone Number	:	786-312-4804
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YAYMA ADAMES
Credential	:
Telephone Number	:	386-315-6339

Provider Enumeration Date	:	10/01/2015
Last Update Date	:	10/01/2015

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