Provider Demographics
NPI:1538413968
Name:GENESIS HEALTH SYSTEM
Entity type:Organization
Organization Name:GENESIS HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:CROPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-421-6510
Mailing Address - Street 1:305 MCKINLEY AVENUE
Mailing Address - Street 2:PO BOX 309
Mailing Address - City:LOWDEN
Mailing Address - State:IA
Mailing Address - Zip Code:52255
Mailing Address - Country:US
Mailing Address - Phone:563-941-5361
Mailing Address - Fax:563-941-5453
Practice Address - Street 1:305 MCKINLEY AVENUE
Practice Address - Street 2:
Practice Address - City:LOWDEN
Practice Address - State:IA
Practice Address - Zip Code:52255
Practice Address - Country:US
Practice Address - Phone:563-941-5361
Practice Address - Fax:563-941-5453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1538413968Medicaid
IA1538413968Medicaid