Provider Demographics
NPI:1467404491
Name:GENESIS HEALTH SYSTEM
Entity Type:Organization
Organization Name:GENESIS HEALTH SYSTEM
Other - Org Name:GENESIS VNA AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:P
Authorized Official - Last Name:CROPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-421-6510
Mailing Address - Street 1:2535 MAPLECREST RD
Mailing Address - Street 2:SUITE 27
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7709
Mailing Address - Country:US
Mailing Address - Phone:563-421-4663
Mailing Address - Fax:563-421-5202
Practice Address - Street 1:2535 MAPLECREST RD
Practice Address - Street 2:SUITE 27
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7709
Practice Address - Country:US
Practice Address - Phone:563-421-5500
Practice Address - Fax:563-421-5202
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-17
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010645251E00000X
IA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0670158Medicaid
IA0670158Medicaid
IL=========006Medicaid