Provider Demographics
NPI:1588894471
Name:GENESIS RESOURCES, INC.
Entity type:Organization
Organization Name:GENESIS RESOURCES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:BYRD
Authorized Official - Last Name:BIERNACKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BHCA, CCM, CPUR
Authorized Official - Phone:954-483-1016
Mailing Address - Street 1:4801 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-7625
Mailing Address - Country:US
Mailing Address - Phone:954-986-4268
Mailing Address - Fax:954-893-7238
Practice Address - Street 1:4801 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-7625
Practice Address - Country:US
Practice Address - Phone:954-986-4268
Practice Address - Fax:954-893-7238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-26
Last Update Date:2009-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW25651041C0700X, 171M00000X
FLRN1372342163W00000X, 163WC0400X, 163WC1600X, 163WG0600X, 163WH0200X
FLRN1226352163WC0400X, 163WC1600X, 163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Multi-Specialty
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff DevelopmentGroup - Multi-Specialty
No163WG0600XNursing Service ProvidersRegistered NurseGerontologyGroup - Multi-Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty