Healthcare Provider Details

I. General information

NPI: 1801182753
Provider Name (Legal Business Name): GENESIS HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 ILLINI DR SUITE 202
SILVIS IL
61282-2907
US

IV. Provider business mailing address

865 LINCOLN RD SUITE L10
BETTENDORF IA
52722-4190
US

V. Phone/Fax

Practice location:
  • Phone: 309-281-2630
  • Fax: 309-281-2639
Mailing address:
  • Phone: 563-355-9200
  • Fax: 563-355-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK G. ROGERS
Title or Position: VP OF FINANCE / CFO
Credential:
Phone: 563-421-6513