Healthcare Provider Details

I. General information

NPI: 1588894471
Provider Name (Legal Business Name): GENESIS RESOURCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2009
Last Update Date: 07/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 JEFFERSON ST
HOLLYWOOD FL
33021-7625
US

IV. Provider business mailing address

4801 JEFFERSON ST
HOLLYWOOD FL
33021-7625
US

V. Phone/Fax

Practice location:
  • Phone: 954-986-4268
  • Fax: 954-893-7238
Mailing address:
  • Phone: 954-986-4268
  • Fax: 954-893-7238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW2565
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1372342
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN1226352
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN1372342
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN1372342
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code163WC1600X
TaxonomyContinuing Education/Staff Development Registered Nurse
License NumberRN1226352
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN1226352
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberRN1372342
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN1372342
License Number StateFL
# 10
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberSW2565
License Number StateFL

VIII. Authorized Official

Name: MRS. ANNA BYRD BIERNACKI
Title or Position: PRESIDENT
Credential: RN, BHCA, CCM, CPUR
Phone: 954-483-1016