Provider Demographics
NPI:1821030115
Name:GENESIS HEALTH DEVELOPMENT INC
Entity type:Organization
Organization Name:GENESIS HEALTH DEVELOPMENT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENI
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-345-7158
Mailing Address - Street 1:3599 UNIVERSITY BLVD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4252
Mailing Address - Country:US
Mailing Address - Phone:904-345-7291
Mailing Address - Fax:904-345-7284
Practice Address - Street 1:13910 FIVAY RD
Practice Address - Street 2:SUITE 6-7
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7154
Practice Address - Country:US
Practice Address - Phone:727-869-9479
Practice Address - Fax:904-345-7284
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS HEALTH DEVELOPMENT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-12
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8869570-01Medicaid
FL106542Medicare Oscar/Certification