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Provider Information for 1689822215



GENESIS HEALTH SYSTEMS

Organization Subpart: NO

Organization NPI: 1689822215

Calendar Last Updated: 2009-02-20

Details

Name Value
NPI 1689822215
Enumeration Date 2008-09-08
NPI Type 2- Organization
Status Active
Mailing Address 209 E BASELINE RD SUITE E102
TEMPE, AZ 85283-1269
United States

Phone: 480-284-8155 | Fax: 866-823-2115
View Map External Link
Primary Practice Address 209 E BASELINE RD SUITE E102
TEMPE, AZ 85283-1269
United States

Phone: 480-284-8155 | Fax: 866-823-2115
View Map External Link
Authorized Official Information Name: DR. HENRY LEE EALY NATUROPATHIC DOCTOR
Title: OWNER/EXECUTIVE COMMUNITY DIRECTOR
Phone: 480-284-8155
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 193200000X MULTI-SPECIALTY GROUP
175F00000X - Naturopath
AZ 07-1041
Other Identifiers
Issuer State Number
Endpoint Information
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location