=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073982831
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENESIS COMMUNITY HEALTH INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2015
-----------------------------------------------------
Last Update Date | 11/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 S DIXIE HWY STE 103
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33432-6034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-430-3629
-----------------------------------------------------
Fax | 561-990-7435
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 639 E OCEAN AVE STE 409
-----------------------------------------------------
City | BOYNTON BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33435-5017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-806-6835
-----------------------------------------------------
Fax | 561-806-6607
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR/CEO
-----------------------------------------------------
Name | DEANNA M WARREN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-735-6553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------