Provider Demographics
NPI:1417556903
Name:GENESIS COMMUNITY MENTAL HEALTH LLC
Entity Type:Organization
Organization Name:GENESIS COMMUNITY MENTAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YAILIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-918-9636
Mailing Address - Street 1:6043 NW 167TH ST STE A10
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-4322
Mailing Address - Country:US
Mailing Address - Phone:786-918-9636
Mailing Address - Fax:
Practice Address - Street 1:6043 NW 167TH ST STE A10
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-4322
Practice Address - Country:US
Practice Address - Phone:786-918-9636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health