NPIMap

Organization Active NPI

Genesis House Recovery Residence Inc.

  • Substance Abuse Rehabilitation Facility
  • Lake Worth, FL
National Provider Identifier
1245383447
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
0950AD652501 Issued in FL
Legal business name
GENESIS HOUSE RECOVERY RESIDENCE INC.
Practice address
4865 40TH Way S
Lake Worth, FL 33461-5301
Phone
(561) 439-4070
Fax
(561) 439-4864
NPI assigned
Jan 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. James Anthony Dodge
Title
Exeutive Director
Phone
(561) 439-4070

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 0950AD652501 FL Primary

Addresses

Primary practice location

4865 40TH Way S
Lake Worth, FL 33461-5301

Mailing address

4865 40TH Way S
Lake Worth, FL 33461-5301
Phone (561) 439-4070

National Provider Directory

National Provider Directory
Tax ID family
Genesis House Recovery Residence Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245383447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4865 40TH WAY S",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334615301",
            "telephone_number": "561-439-4070",
            "fax_number": "561-439-4864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4865 40TH WAY S",
            "city": "LAKE WORTH",
            "state": "FL",
            "postal_code": "334615301",
            "telephone_number": "561-439-4070",
            "fax_number": "561-439-4864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS HOUSE RECOVERY RESIDENCE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DODGE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "EXEUTIVE DIRECTOR",
        "authorized_official_telephone_number": "561-439-4070",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "FL",
            "license": "0950AD652501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Worth, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.