Organization
GENESIS DEVELOPMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY JOHNSON (CEO)
(515) 386-3017
Entity
Organization
Contact information
Practice address
401 W MCKINLEY ST, JEFFERSON, IA 50129-1421
(515) 386-3017
(515) 386-4642
Mailing address
PO BOX 438, JEFFERSON, IA 50129-0438
(515) 386-3017
(515) 386-4642
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
311ZA0620X
Adult Care Home Facility
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0110726
—
IA
05
—
0232363
—
IA
05
—
0243121
—
IA
05
—
0245811
—
IA
05
—
0245829
—
IA
05
—
0280529
—
IA
05
—
0290353
—
IA
05
—
0428656
—
IA
05
—
0465393
—
IA
05
—
0465401
—
IA
05
—
0465419
—
IA
05
—
0465435
—
IA
05
—
0465534
—
IA
05
—
0890007
—
IA
05
—
0894865
—
IA
05
—
1232363
—
IA
05
—
1245811
—
IA
01
—
15-08-003
NON POS AGREEMENT NUMBER
IA
Enumeration date
01/31/2006
Last updated
05/05/2010
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