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GENESIS HOUSE RECOVERY RESIDENCE INC. NPI 1245383447


NPI Information

NPI: 1245383447
Provider Name: GENESIS HOUSE RECOVERY RESIDENCE INC.
Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization

CLIA Number: 10D2019812

Address:
4865 40TH WAY S
LAKE WORTH, FL
ZIP 33461
Phone: (561) 439-4070
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GENESIS HOUSE RECOVERY RESIDENCE INC. is a substance abuse rehabilitation facility in Lake Worth, FL. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. GENESIS HOUSE RECOVERY RESIDENCE INC. NPI is 1245383447. The provider is registered as an organization entity type.

The provider's business location address is:

4865 40TH WAY S
LAKE WORTH, FL
ZIP 33461-301
Phone: (561) 439-4070
Fax: (561) 439-4864

The provider's authorized official is James Anthony Dodge .
The authorized official title is Exeutive Director and has the following contact phone number (561) 439-4070.

The CLIA number assigned to this NPI record is 10D2019812 - other - residential treatment fac with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/19/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1324500000XSubstance Abuse Rehabilitation Facility0950AD652501FLORIDAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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