Healthcare Provider Details

I. General information

NPI: 1700882628
Provider Name (Legal Business Name): GENESIS HEALTHCARE SYSTEMS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 STEWART ST
LAFAYETTE LA
70501-8539
US

IV. Provider business mailing address

847 STEWART ST
LAFAYETTE LA
70501-8539
US

V. Phone/Fax

Practice location:
  • Phone: 337-237-4673
  • Fax: 337-237-4674
Mailing address:
  • Phone: 337-237-4673
  • Fax: 337-237-4674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number1118605
License Number StateLA

VIII. Authorized Official

Name: WILL J ARLEDGE
Title or Position: CFO
Credential:
Phone: 337-237-4673