Healthcare Provider Details

I. General information

NPI: 1639255730
Provider Name (Legal Business Name): GENESIS HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 FOREST AVE
ZANESVILLE OH
43701-2819
US

IV. Provider business mailing address

713 FOREST AVE
ZANESVILLE OH
43701-2819
US

V. Phone/Fax

Practice location:
  • Phone: 740-454-5365
  • Fax: 740-455-7592
Mailing address:
  • Phone: 740-454-5365
  • Fax: 740-455-7592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number0013HSP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0013HSP
License Number StateOH

VIII. Authorized Official

Name: MICHAEL NORMAN
Title or Position: CFO
Credential:
Phone: 740-454-4773