Provider Demographics
NPI:1437402831
Name:GENESIS COMMUNITY HEALTH INC
Entity Type:Organization
Organization Name:GENESIS COMMUNITY HEALTH INC
Other - Org Name:MAE VOLEN CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/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 1:564 E WOOLBRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-6033
Mailing Address - Country:US
Mailing Address - Phone:561-735-6553
Mailing Address - Fax:561-735-7739
Practice Address - Street 1:1515 W PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-3307
Practice Address - Country:US
Practice Address - Phone:561-395-8920
Practice Address - Fax:561-338-9127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)