Genesis LLC

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Legal business name

GENESIS LLC

Practice address

1007 W Broadway Ave
Minneapolis, MN 55411-2503

Phone

(952) 221-9987

Fax

(612) 486-8694

NPI assigned

Mar 4, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wilma Denise King

Title

President

Phone

(612) 408-9084

Specialties & licenses 4

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1174380463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2143 ALBEMARLE CT N",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551136677",
            "telephone_number": "952-221-9987",
            "fax_number": "612-486-8694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 W BROADWAY AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554112503",
            "telephone_number": "952-221-9987",
            "fax_number": "612-486-8694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-04",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-03",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "WILMA",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-408-9084"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Health & Wellness Coach",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Case Manager/Care Coordinator in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.