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General NPI Number Information
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NPI Number | 1760088132
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Entity Type | Organization
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Legal Business Name | GENESIS COMMUNITY CARE INCORPORATED
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 2210 PIERCE ST
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City | HOLLYWOOD
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State | FL
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Zip | 33020-4414
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Country | US
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Telephone | 786-262-3668
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Fax |
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Provider Business Mailing Address
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Address Line | 4290 SW 141ST AVE
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City | MIRAMAR
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State | FL
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Zip | 33027-3040
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Country | US
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Telephone | 786-262-3668
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | FELICIA SENETTA ALI
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Credential |
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Telephone | 786-262-3668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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