MEDICARE: GENESIS HEALTH NETWORK, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170100000X	Ph.D. Medical Genetics

General Provider Information

NPI Number	:	1770500654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS HEALTH NETWORK, INC

Provider Business Mailing Address
First Line	:	4335 NW SOUTH TAMIAMI CANAL DR
Second Line	:	#316
City	:	MIAMI
State	:	FL
Zip	:	33126-1486
Country	:	US
Telephone Number	:	786-222-1694
Fax Number	:

Provider Business Practice Location Address
First Line	:	4335 NW SOUTH TAMIAMI CANAL DR
Second Line	:	#316
City	:	MIAMI
State	:	FL
Zip	:	33126-1486
Country	:	US
Telephone Number	:	786-222-1694
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DIOSDADO REYES
Credential	:
Telephone Number	:	786-222-1694

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	08/22/2020

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