Basic Information
| Provider Information | |||||||||
| NPI: | 1740864164 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENESIS HEALTH DEVELOPMENT, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3599 UNIVERSITY BLVD S | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322164252 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1885 S 14TH ST | ||||||||
| Address2: | |||||||||
| City: | FERNANDINA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320343033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042774449 | ||||||||
| FaxNumber: | 9042774177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2021 | ||||||||
| LastUpdateDate: | 05/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | PORTUGAL | ||||||||
| AuthorizedOfficialFirstName: | KELLI | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR, MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 9043457158 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 04/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
No ID Information.