Healthcare Provider Details

I. General information

NPI: 1609457399
Provider Name (Legal Business Name): GENESIS HEALTH DEVELOPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 W TOWN PL STE 5
ST AUGUSTINE FL
32092-3102
US

IV. Provider business mailing address

3599 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4252
US

V. Phone/Fax

Practice location:
  • Phone: 386-775-7488
  • Fax: 386-775-9515
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENI ALLEN
Title or Position: DIRECTOR OF MANAGED CARE
Credential:
Phone: 904-345-7158