Provider Demographics
NPI:1871936336
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:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:M
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 1:181 CRAWFORD BLVD FL 1
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-3743
Practice Address - Country:US
Practice Address - Phone:561-235-5477
Practice Address - Fax:561-770-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-15
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)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006608603Medicaid