Organization
GENESIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILMA DENISE KING (PRESIDENT)
(612) 408-9084
Entity
Organization
Contact information
Practice address
1007 W BROADWAY AVE, MINNEAPOLIS, MN 55411-2503
(952) 221-9987
(612) 486-8694
Mailing address
2143 ALBEMARLE CT N, ROSEVILLE, MN 55113-6677
(952) 221-9987
(612) 486-8694
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171400000X
Health & Wellness Coach
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
172V00000X
Community Health Worker
—
—
Other
Enumeration date
03/04/2024
Last updated
03/04/2024
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