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General NPI Number Information
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NPI Number | 1205860400
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Entity Type | Organization
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Legal Business Name | GENESIS HEALTH SYSTEM
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1520 W 53RD ST
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City | DAVENPORT
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State | IA
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Zip | 52806-2459
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Country | US
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Telephone | 563-421-3800
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Fax | 563-421-3810
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Provider Business Mailing Address
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Address Line | PO BOX 765
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City | EAST MOLINE
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State | IL
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Zip | 61244-0765
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Country | US
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Telephone | 563-355-9200
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Fax | 563-355-3415
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Authorized Official
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Title or Position | VP OF FINANCE
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Name | MR. MARK G ROGERS
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Credential |
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Telephone | 563-421-6513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | IA
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