Healthcare Provider Details

I. General information

NPI: 1497772008
Provider Name (Legal Business Name): GENESIS HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4017 DEVILS GLEN RD
BETTENDORF IA
52722-7221
US

IV. Provider business mailing address

PO BOX 765
EAST MOLINE IL
61244-0765
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-3700
  • Fax: 563-421-3710
Mailing address:
  • Phone: 563-355-9200
  • Fax: 563-355-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateIA

VIII. Authorized Official

Name: MR. MARK G ROGERS
Title or Position: INTERIM CFO
Credential:
Phone: 563-421-6513