Healthcare Provider Details

I. General information

NPI: 1588094767
Provider Name (Legal Business Name): GENESIS CASE MANAGEMENT SERVICES, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 NW 165TH STREET RD SUITE 110
MIAMI FL
33169-6304
US

IV. Provider business mailing address

540 NW 165TH STREET RD SUITE 110
MIAMI FL
33169-6304
US

V. Phone/Fax

Practice location:
  • Phone: 786-953-4612
  • Fax: 786-953-8534
Mailing address:
  • Phone: 786-953-4612
  • Fax: 786-953-8534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ANTOINE TONY ROUSE
Title or Position: OWNER/CEO
Credential: BSW, RN, BSN
Phone: 954-695-1258