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General NPI Number Information
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NPI Number | 1518522275
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Entity Type | Organization
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Legal Business Name | GENESIS HEALTH CENTER LLC
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Dates
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Enumeration Date | 05/07/2019
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Last Update Date | 09/11/2023
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Provider Practice Location Address
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Address Line | 50 LINDSEY CT STE 101-103
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City | HIALEAH
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State | FL
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Zip | 33010-5243
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Country | US
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Telephone | 954-643-3848
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Fax |
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Provider Business Mailing Address
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Address Line | 5881 NW 151ST ST STE 112
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2455
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Country | US
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Telephone | 954-643-3848
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Fax |
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Authorized Official
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Title or Position | MGR
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Name | MIRIAN GOMEZ
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Credential |
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Telephone | 954-643-3848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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