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General NPI Number Information
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NPI Number | 1235993155
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Entity Type | Organization
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Legal Business Name | GENESIS WELLNESS SUPPORT CORP
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 07/05/2025
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Provider Practice Location Address
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Address Line | 10700 CARIBBEAN BLVD STE 214
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City | CUTLER BAY
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State | FL
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Zip | 33189-1233
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Country | US
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Telephone | 786-207-1151
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Fax | 786-221-2834
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Provider Business Mailing Address
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Address Line | 9333 SW 227TH ST UNIT 1
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City | CUTLER BAY
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State | FL
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Zip | 33190-1947
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Country | US
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Telephone | 786-740-0516
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Fax | 786-221-2834
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Authorized Official
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Title or Position | OWNER
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Name | YISCEL MARIA M PASCUAL BERMUDEZ
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Credential | CBHCMS
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Telephone | 786-740-0516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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