Provider Demographics
NPI:1770500654
Name:GENESIS HEALTH NETWORK, INC
Entity type:Organization
Organization Name:GENESIS HEALTH NETWORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIOSDADO
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-222-1694
Mailing Address - Street 1:4335 NW SOUTH TAMIAMI CANAL DR
Mailing Address - Street 2:#316
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1486
Mailing Address - Country:US
Mailing Address - Phone:786-222-1694
Mailing Address - Fax:
Practice Address - Street 1:4335 NW SOUTH TAMIAMI CANAL DR
Practice Address - Street 2:#316
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1486
Practice Address - Country:US
Practice Address - Phone:786-222-1694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4883Medicare ID - Type Unspecified