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General NPI Number Information
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NPI Number | 1215438981
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Entity Type | Organization
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Legal Business Name | GENESIS COMMUNITY HEALTH, INC.
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 2623 S SEACREST BLVD STE 112
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-7531
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Country | US
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Telephone | 561-810-8790
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Fax | 561-810-8793
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Provider Business Mailing Address
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Address Line | 639 E OCEAN AVE STE 409
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-5017
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Country | US
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Telephone | 561-806-6835
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Fax | 561-806-6607
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DEANNA WARREN
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Credential |
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Telephone | 561-806-6835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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