# GENESIS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700021441
- **Authorized official:** CARLA JOANNE HANNAH (PROVIDER)
- **Authorized official phone:** (469) 835-6428

## Contact information

- **Practice address:** 700 WALNUT RIDGE DR, 3055, IRVING, TX 75038-1000
- **Practice address phone:** (469) 835-6428
- **Practice address fax:** (972) 871-2740
- **Mailing address:** 700 WALNUT RIDGE DR, 3055, IRVING, TX 75038-1000
- **Mailing address phone:** (469) 835-6428
- **Mailing address fax:** (972) 871-2740

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | 835552 | TX | Yes |

## Other

- **Enumeration date:** 12/09/2008
- **Last updated:** 12/09/2008