Genesis Development

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

GENESIS DEVELOPMENT

Practice address

401 W McKinley St
Jefferson, IA 50129-1421

Phone

(515) 386-3017

Fax

(515) 386-4642

NPI assigned

Jan 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Terry Johnson

Title

Ceo

Phone

(515) 386-3017

Specialties & licenses 8

Addresses

Other identifiers 18

Tax ID family

Genesis Development2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Genesis Development

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Jefferson, IA
  • NPI 1942327283
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273017600000",
    "number": "1003887639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 438",
            "city": "JEFFERSON",
            "state": "IA",
            "postal_code": "501290438",
            "telephone_number": "515-386-3017",
            "fax_number": "515-386-4642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W MCKINLEY ST",
            "city": "JEFFERSON",
            "state": "IA",
            "postal_code": "501291421",
            "telephone_number": "515-386-3017",
            "fax_number": "515-386-4642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS DEVELOPMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-31",
        "last_updated": "2010-05-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "515-386-3017",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0465401",
            "state": "IA"
        },
        {
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            "issuer": null,
            "identifier": "0465419",
            "state": "IA"
        },
        {
            "code": "05",
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            "issuer": null,
            "identifier": "1232363",
            "state": "IA"
        },
        {
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            "identifier": "0280529",
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            "identifier": "0465435",
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        {
            "code": "05",
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            "issuer": null,
            "identifier": "0428656",
            "state": "IA"
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        {
            "code": "05",
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            "issuer": null,
            "identifier": "0465393",
            "state": "IA"
        },
        {
            "code": "05",
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            "issuer": null,
            "identifier": "0243121",
            "state": "IA"
        },
        {
            "code": "05",
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            "issuer": null,
            "identifier": "0465534",
            "state": "IA"
        },
        {
            "code": "05",
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            "issuer": null,
            "identifier": "0110726",
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        {
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        {
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            "issuer": null,
            "identifier": "0245829",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0890007",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NON POS AGREEMENT NUMBER",
            "identifier": "15-08-003",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0245811",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0894865",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245811",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0290353",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Jefferson, IA
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.