Provider Demographics
NPI:1093124216
Name:GENESEE HEALTH SYSTEM
Entity Type:Organization
Organization Name:GENESEE HEALTH SYSTEM
Other - Org Name:GENESEE COMMUNITY HEALTH CENTER-SHELTER OF FLINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEPIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-496-5797
Mailing Address - Street 1:422 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2404
Mailing Address - Country:US
Mailing Address - Phone:810-496-5777
Mailing Address - Fax:810-496-5798
Practice Address - Street 1:924 CEDAR ST
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-3620
Practice Address - Country:US
Practice Address - Phone:810-238-4711
Practice Address - Fax:810-238-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-13
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X
MI4704225065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty