Healthcare Provider Details

I. General information

NPI: 1447578125
Provider Name (Legal Business Name): GENESIS COMMUNITY HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 S FEDERAL HWY STE 3
BOYNTON BEACH FL
33435-5610
US

IV. Provider business mailing address

639 E OCEAN AVE STE 409
BOYNTON BEACH FL
33435-5017
US

V. Phone/Fax

Practice location:
  • Phone: 561-735-6553
  • Fax: 561-735-7739
Mailing address:
  • Phone: 561-806-6835
  • Fax: 561-806-6607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DEANNA MOULTRIE WARREN
Title or Position: CEO
Credential:
Phone: 561-735-6553