Provider Demographics
NPI:1811944382
Name:GENESIS HEALTHCARE SYSTEM
Entity type:Organization
Organization Name:GENESIS HEALTHCARE SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-454-4773
Mailing Address - Street 1:133 N MAYSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-6112
Mailing Address - Country:US
Mailing Address - Phone:740-454-5666
Mailing Address - Fax:740-452-7563
Practice Address - Street 1:10 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CONCORD
Practice Address - State:OH
Practice Address - Zip Code:43762-1286
Practice Address - Country:US
Practice Address - Phone:740-826-4000
Practice Address - Fax:740-826-4950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0217363503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2784509Medicaid
OH3623281OtherN.C.P.D.P. #
OH0437550008Medicare NSC