Healthcare Provider Details

I. General information

NPI: 1427097716
Provider Name (Legal Business Name): GENESIS HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 W CENTRAL PARK AVE
DAVENPORT IA
52804-1707
US

IV. Provider business mailing address

1227 E RUSHOLME ST
DAVENPORT IA
52803-2459
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-3402
  • Fax: 563-421-3419
Mailing address:
  • Phone: 563-421-3402
  • Fax: 563-421-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number StateIA

VIII. Authorized Official

Name: JOSEPH D MALAS
Title or Position: CFO
Credential:
Phone: 563-421-6508