Basic Information
| Provider Information | |||||||||
| NPI: | 1417673179 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GENESIS HEALTHCARE SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 751 FOREST AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437012875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404546970 | ||||||||
| FaxNumber: | 7404529514 | ||||||||
| Practice Location | |||||||||
| Address1: | 751 FOREST AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | ZANESVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437012875 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404546970 | ||||||||
| FaxNumber: | 7404529514 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2022 | ||||||||
| LastUpdateDate: | 10/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | NORMAN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7404544773 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 10/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | N | Suppliers | Pharmacy | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.