Provider Demographics
NPI:1740745512
Name:GENESIS COMMUNITY HEALTH, INC
Entity Type:Organization
Organization Name:GENESIS COMMUNITY HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-806-6835
Mailing Address - Street 1:2623 S SEACREST BLVD STE 65
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7541
Mailing Address - Country:US
Mailing Address - Phone:561-806-6835
Mailing Address - Fax:561-806-6607
Practice Address - Street 1:2623 S SEACREST BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7531
Practice Address - Country:US
Practice Address - Phone:561-735-6553
Practice Address - Fax:561-735-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)