Provider Demographics
NPI:1073982831
Name:GENESIS COMMUNITY HEALTH INC
Entity Type:Organization
Organization Name:GENESIS COMMUNITY HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-735-6553
Mailing Address - Street 1:2623 S SEACREST BLVD
Mailing Address - Street 2:SUITE 65
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7541
Mailing Address - Country:US
Mailing Address - Phone:561-835-6553
Mailing Address - Fax:561-735-7739
Practice Address - Street 1:600 S DIXIE HWY STE 103
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-6034
Practice Address - Country:US
Practice Address - Phone:561-430-3629
Practice Address - Fax:561-990-7435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)