Provider Demographics
NPI:1265875108
Name:GENESIS TCM CORP
Entity type:Organization
Organization Name:GENESIS TCM CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-350-7911
Mailing Address - Street 1:3700 34TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-6601
Mailing Address - Country:US
Mailing Address - Phone:407-350-7911
Mailing Address - Fax:
Practice Address - Street 1:3700 34TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-6601
Practice Address - Country:US
Practice Address - Phone:407-350-7911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management