Provider Demographics
NPI:1447578125
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:MOULTRIE
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-735-6553
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:561-806-6607
Practice Address - Street 1:709 S FEDERAL HWY STE 3
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-5610
Practice Address - Country:US
Practice Address - Phone:561-735-6553
Practice Address - Fax:561-735-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002267000Medicaid
FLEC290AOtherMEDICARE
FL006608600Medicaid
FL101108OtherMEDICARE