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General NPI Number Information
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NPI Number | 1619282837
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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 | 08/12/2010
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Last Update Date | 07/25/2011
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Provider Practice Location Address
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Address Line | 2350 41ST ST
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City | MOLINE
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State | IL
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Zip | 61265-5014
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Country | US
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Telephone | 309-764-0684
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Fax | 309-764-0686
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Provider Business Mailing Address
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Address Line | PO BOX 1246
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City | MOLINE
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State | IL
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Zip | 61266-1246
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Country | US
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Telephone | 309-764-0684
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Fax | 309-764-0686
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Authorized Official
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Title or Position | VP/CFO
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Name | MARK 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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 0005413
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License Number State | IL
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