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  5. GENESIS HOUSE RECOVERY RESIDENCE, INC.

GENESIS HOUSE RECOVERY RESIDENCE, INC.

Company Details

Entity Name: GENESIS HOUSE RECOVERY RESIDENCE, INC.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 03 Sep 1993 (31 years ago)
Document Number: P93000062440
FEI/EIN Number 650456525
Address: 4865 40TH WAY S, LAKE WORTH, FL, 33461
Mail Address: 4865 40TH WAY S, LAKE WORTH, FL, 33461
ZIP code: 33461
County: Palm Beach
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1245383447 2007-01-19 2020-08-22 4865 40TH WAY S, LAKE WORTH, FL, 334615301, US 4865 40TH WAY S, LAKE WORTH, FL, 334615301, US

Contacts
Phone +1 561-439-4070
Fax 5614394864

Authorized person
Name MR. JAMES ANTHONY DODGE
Role EXEUTIVE DIRECTOR
Phone 5614394070

Taxonomy
Taxonomy Code 324500000X - Substance Abuse Rehabilitation Facility
License Number 0950AD652501
State FL
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
GENESIS HOUSE RECOVERY RESIDENCE, INC. PROFIT SHARING PLAN 2021 650456525 2022-12-01 GENESIS HOUSE RECOVERY RESIDENCE, INC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621420
Sponsor’s telephone number 8007370933
Plan sponsor’s address 4865 40TH WAY SOUTH, LAKE WORTH, FL, 33461

Signature of
Role Plan administrator
Date 2022-12-01
Name of individual signing TAYLOR DODGE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-12-01
Name of individual signing TAYLOR DODGE
Valid signature Filed with authorized/valid electronic signature
GENESIS HOUSE RECOVERY RESIDENCE, INC. PROFIT SHARING PLAN 2021 650456525 2022-05-05 GENESIS HOUSE RECOVERY RESIDENCE, INC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621420
Sponsor’s telephone number 8007370933
Plan sponsor’s address 4865 40TH WAY SOUTH, LAKE WORTH, FL, 33461

Signature of
Role Plan administrator
Date 2022-05-05
Name of individual signing TAYLOR DODGE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2022-05-05
Name of individual signing TAYLOR DODGE
Valid signature Filed with authorized/valid electronic signature
GENESIS HOUSE RECOVERY RESIDENCE, INC. PROFIT SHARING PLAN 2020 650456525 2021-04-26 GENESIS HOUSE RECOVERY RESIDENCE, INC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621420
Sponsor’s telephone number 8007370933
Plan sponsor’s address 4865 40TH WAY SOUTH, LAKE WORTH, FL, 33461

Signature of
Role Plan administrator
Date 2021-04-26
Name of individual signing TAYLOR DODGE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2021-04-26
Name of individual signing TAYLOR DODGE
Valid signature Filed with authorized/valid electronic signature
GENESIS HOUSE RECOVERY RESIDENCE, INC. PROFIT SHARING PLAN 2019 650456525 2020-04-20 GENESIS HOUSE RECOVERY RESIDENCE, INC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621420
Sponsor’s telephone number 8007370933
Plan sponsor’s address 4865 40TH WAY SOUTH, LAKE WORTH, FL, 33461

Signature of
Role Plan administrator
Date 2020-04-20
Name of individual signing TAYLOR DODGE
Valid signature Filed with authorized/valid electronic signature
GENESIS HOUSE RECOVERY RESIDENCE, INC. PROFIT SHARING PLAN 2018 650456525 2019-04-15 GENESIS HOUSE RECOVERY RESIDENCE, INC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621420
Sponsor’s telephone number 8007370933
Plan sponsor’s address 4865 40TH WAY SOUTH, LAKE WORTH, FL, 33461

Signature of
Role Plan administrator
Date 2019-04-15
Name of individual signing TAYLOR DODGE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-04-15
Name of individual signing TAYLOR DODGE
Valid signature Filed with incorrect/unrecognized electronic signature
GENESIS HOUSE RECOVERY RESIDENCE, INC. PROFIT SHARING PLAN 2017 650456525 2018-05-01 GENESIS HOUSE RECOVERY RESIDENCE, INC. 24
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621420
Sponsor’s telephone number 8007370933
Plan sponsor’s address 4865 40TH WAY SOUTH, LAKE WORTH, FL, 33461

Signature of
Role Plan administrator
Date 2018-05-01
Name of individual signing TAYLOR DODGE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-05-01
Name of individual signing TAYLOR DODGE
Valid signature Filed with authorized/valid electronic signature
GENESIS HOUSE RECOVERY RESIDENCE, INC. PROFIT SHARING PLAN 2016 650456525 2017-07-14 GENESIS HOUSE RECOVERY RESIDENCE, INC. 28
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621420
Sponsor’s telephone number 8007370933
Plan sponsor’s address 4865 40TH WAY SOUTH, LAKE WORTH, FL, 33461

Signature of
Role Plan administrator
Date 2017-07-14
Name of individual signing TAYLOR DODGE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-14
Name of individual signing TAYLOR DODGE
Valid signature Filed with authorized/valid electronic signature
GENESIS HOUSE RECOVERY RESIDENCE, INC. PROFIT SHARING PLAN 2015 650456525 2016-07-20 GENESIS HOUSE RECOVERY RESIDENCE, INC. 26
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621420
Sponsor’s telephone number 8007370933
Plan sponsor’s address 4865 40TH WAY SOUTH, LAKE WORTH, FL, 33461

Signature of
Role Plan administrator
Date 2016-07-20
Name of individual signing JAMES A DODGE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-20
Name of individual signing JAMES A DODGE
Valid signature Filed with authorized/valid electronic signature
GENESIS HOUSE RECOVERY RESIDENCE, INC. PROFIT SHARING PLAN 2014 650456525 2015-05-05 GENESIS HOUSE RECOVERY RESIDENCE, INC. 25
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621420
Sponsor’s telephone number 8007370933
Plan sponsor’s address 4865 40TH WAY SOUTH, LAKE WORTH, FL, 33461

Signature of
Role Plan administrator
Date 2015-05-05
Name of individual signing JAMES A DODGE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-05-05
Name of individual signing JAMES A DODGE
Valid signature Filed with authorized/valid electronic signature
GENESIS HOUSE RECOVERY RESIDENCE, INC. PROFIT SHARING PLAN 2013 650456525 2014-06-19 GENESIS HOUSE RECOVERY RESIDENCE, INC. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621420
Sponsor’s telephone number 8007370933
Plan sponsor’s address 4865 40TH WAY SOUTH, LAKE WORTH, FL, 33461

Signature of
Role Plan administrator
Date 2014-06-19
Name of individual signing JAMES DODGE
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2014-06-19
Name of individual signing JAMES DODGE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
Advantage Accounting & Tax Agent 2700 North Military Trail, Boca Raton, FL, 33431

Vice President

Name Role Address
HOWARD DODGE STEPHANIE Vice President 1207 HAMMOND RD, DELRAY BEACH, FL, 33483

President

Name Role Address
DODGE TAYLOR President 4865 40TH WAY SOUTH, Lake Worth, FL, 33461

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Related by address

No related companies by address

Date of last update: 01 Jan 2025

Sources: Florida Department of State

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