Healthcare Provider Details

I. General information

NPI: 1407938269
Provider Name (Legal Business Name): GENESIS HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 11TH ST
DE WITT IA
52742-1235
US

IV. Provider business mailing address

1118 11TH ST
DE WITT IA
52742-1235
US

V. Phone/Fax

Practice location:
  • Phone: 563-659-4200
  • Fax: 563-421-3419
Mailing address:
  • Phone: 563-659-4200
  • Fax: 563-421-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number StateIA

VIII. Authorized Official

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