Healthcare Provider Details

I. General information

NPI: 1518522275
Provider Name (Legal Business Name): GENESIS HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LINDSEY CT STE 101-103
HIALEAH FL
33010-5243
US

IV. Provider business mailing address

5881 NW 151ST ST STE 112
MIAMI LAKES FL
33014-2455
US

V. Phone/Fax

Practice location:
  • Phone: 954-643-3848
  • Fax:
Mailing address:
  • Phone: 954-643-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MIRIAN GOMEZ
Title or Position: MGR
Credential:
Phone: 954-643-3848