Provider Demographics
NPI:1124804182
Name:GENESIS HEALTH SYSTEM
Entity type:Organization
Organization Name:GENESIS HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:MALAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-421-6508
Mailing Address - Street 1:PO BOX 4028
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61204-4028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1021 11TH ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1209
Practice Address - Country:US
Practice Address - Phone:563-659-9294
Practice Address - Fax:563-659-8104
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-06
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center