Healthcare Provider Details

I. General information

NPI: 1376453605
Provider Name (Legal Business Name): GENESIS COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 S UNIVERSITY DR STE 118
DAVIE FL
33328-5309
US

IV. Provider business mailing address

5400 S UNIVERSITY DR STE 118
DAVIE FL
33328-5309
US

V. Phone/Fax

Practice location:
  • Phone: 954-960-4740
  • Fax: 888-353-5181
Mailing address:
  • Phone: 954-960-4740
  • Fax: 954-827-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JUAN RODRIGUEZ
Title or Position: MEMBER
Credential:
Phone: 954-960-4740