Provider Demographics
NPI:1689822215
Name:GENESIS HEALTH SYSTEMS
Entity type:Organization
Organization Name:GENESIS HEALTH SYSTEMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EXECUTIVE COMMUNITY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:EALY
Authorized Official - Suffix:III
Authorized Official - Credentials:NATUROPATHIC DOCTOR
Authorized Official - Phone:480-284-8155
Mailing Address - Street 1:209 E BASELINE RD
Mailing Address - Street 2:SUITE E102
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1269
Mailing Address - Country:US
Mailing Address - Phone:480-284-8155
Mailing Address - Fax:866-823-2115
Practice Address - Street 1:209 E BASELINE RD
Practice Address - Street 2:SUITE E102
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1269
Practice Address - Country:US
Practice Address - Phone:480-284-8155
Practice Address - Fax:866-823-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-08
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07-1041175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty