Provider Demographics
NPI:1447204375
Name:GENESIS HEALTH SYSTEM
Entity Type:Organization
Organization Name:GENESIS HEALTH SYSTEM
Other - Org Name:ILLINI RESTORATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-281-3272
Mailing Address - Street 1:1455 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:SILVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61282-1834
Mailing Address - Country:US
Mailing Address - Phone:309-281-3272
Mailing Address - Fax:309-281-3269
Practice Address - Street 1:1455 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-1834
Practice Address - Country:US
Practice Address - Phone:309-281-3272
Practice Address - Fax:309-281-3269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL282E00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
A6128206OtherJOHN DEERE HEALTHCARE
IL0973OtherILLINOIS BLUE CROSS
IL0973OtherILLINOIS BLUE CROSS
IL=========001Medicaid