Healthcare Provider Details

I. General information

NPI: 1073210985
Provider Name (Legal Business Name): GENESIS HOPEFUL HAVEN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19000 SW 112TH AVE
CUTLER BAY FL
33157-6600
US

IV. Provider business mailing address

19000 SW 112TH AVE
CUTLER BAY FL
33157-6600
US

V. Phone/Fax

Practice location:
  • Phone: 786-227-6704
  • Fax:
Mailing address:
  • Phone: 786-571-9604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State

VIII. Authorized Official

Name: FRITZIE SAINTOIRY
Title or Position: CEO
Credential: LCSW
Phone: 786-571-9604