MEDICARE: GENESIS ALF LLC

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	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9693	OTHER	FL	AHCA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992452031
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENESIS ALF LLC

Provider Business Mailing Address
First Line	:	4183 E 8TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-2401
Country	:	US
Telephone Number	:	305-953-4056
Fax Number	:	786-803-8455

Provider Business Practice Location Address
First Line	:	4183 E 8TH CT
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-2401
Country	:	US
Telephone Number	:	305-953-4056
Fax Number	:	786-803-8455

Authorized Official
Title or Position	:	OWNER
Name	:	DAYANA DELGADO
Credential	:
Telephone Number	:	305-713-0491

Provider Enumeration Date	:	03/08/2022
Last Update Date	:	03/08/2022

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Directions to “GENESIS ALF LLC ” Practice Location

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