Provider Demographics
NPI:1285415661
Name:GENESIS COMMUNITY HEALTH, INC
Entity type:Organization
Organization Name:GENESIS COMMUNITY HEALTH, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-806-6835
Mailing Address - Street 1:639 E OCEAN AVE STE 409
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-5017
Mailing Address - Country:US
Mailing Address - Phone:561-806-6835
Mailing Address - Fax:
Practice Address - Street 1:4975 PARK RIDGE BLVD BLDG 5
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8318
Practice Address - Country:US
Practice Address - Phone:561-806-6835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-11
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)