| Genesis Community Mental Health Llc | |
|
6043 Nw 167th St Ste A10 Hialeah FL 33015-4322 | |
| (786) 918-9636 | |
| Not Available |
| Full Name | Genesis Community Mental Health Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 6043 Nw 167th St Ste A10, Hialeah, Florida |
| Authorized Official Name and Position | Yailin Medina (ADMINISTRATOR) |
| Authorized Official Contact | 7869189636 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Community Mental Health Llc 6043 Nw 167th St Ste A10 Hialeah FL 33015-4322 Ph: (786) 918-9636 | Genesis Community Mental Health Llc 6043 Nw 167th St Ste A10 Hialeah FL 33015-4322 Ph: (786) 918-9636 |
| NPI Number | 1417556903 |
|---|---|
| Provider Enumeration Date | 10/26/2020 |
| Last Update Date | 10/26/2020 |
| Certification Date | 10/26/2020 |
| Medicare PECOS PAC ID | 8022405810 |
|---|---|
| Medicare Enrollment ID | O20220426000759 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417556903 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Diamina Molina Vidal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861970428 PECOS PAC ID: 0143568626 Enrollment ID: I20190207001164 |
| Provider Name | Eric Miller |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851557813 PECOS PAC ID: 7618016619 Enrollment ID: I20211112002003 |
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