| Genesis Community Care Incorporated | |
|
2210 Pierce St Hollywood FL 33020-4414 | |
| (786) 262-3668 | |
| Not Available |
| Full Name | Genesis Community Care Incorporated |
|---|---|
| Speciality | Clinic/Center |
| Location | 2210 Pierce St, Hollywood, Florida |
| Authorized Official Name and Position | Felicia Senetta Ali (DIRECTOR) |
| Authorized Official Contact | 7862623668 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Community Care Incorporated 4290 Sw 141st Ave Miramar FL 33027-3040 Ph: (786) 262-3668 | Genesis Community Care Incorporated 2210 Pierce St Hollywood FL 33020-4414 Ph: (786) 262-3668 |
| NPI Number | 1760088132 |
|---|---|
| Provider Enumeration Date | 12/09/2020 |
| Last Update Date | 12/09/2020 |
| Certification Date | 12/09/2020 |
| Medicare PECOS PAC ID | 6507230927 |
|---|---|
| Medicare Enrollment ID | O20230324001717 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760088132 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Eric Miller |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851557813 PECOS PAC ID: 7618016619 Enrollment ID: I20211112002003 |
| Provider Name | Marcheley Adam |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508003369 PECOS PAC ID: 6507221694 Enrollment ID: I20230425000244 |
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