Provider Demographics
NPI:1548617459
Name:GENESEE HEALTH SYSTEM
Entity Type:Organization
Organization Name:GENESEE HEALTH SYSTEM
Other - Org Name:WATER WAIVER
Other - Org Type:Other Name
Authorized Official - Title/Position:REIMBURSEMENT OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TROOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-496-5543
Mailing Address - Street 1:725 MASON ST
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2421
Mailing Address - Country:US
Mailing Address - Phone:810-257-3736
Mailing Address - Fax:810-257-3785
Practice Address - Street 1:420 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2445
Practice Address - Country:US
Practice Address - Phone:810-257-3740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-20
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty