Provider Demographics
NPI:1013968262
Name:GENESIS HEALTH SYSTEM
Entity Type:Organization
Organization Name:GENESIS HEALTH SYSTEM
Other - Org Name:GENESIS HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
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 4
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7709
Mailing Address - Country:US
Mailing Address - Phone:563-421-5400
Mailing Address - Fax:
Practice Address - Street 1:2535 MAPLECREST RD
Practice Address - Street 2:SUITE 4
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-7709
Practice Address - Country:US
Practice Address - Phone:563-421-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-12
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2002574251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0615849Medicaid
IA0615849Medicaid
IA0615849Medicaid