Organization
GENESIS DEVELOPMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY L 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
—
—
253Z00000X
In Home Supportive Care Agency
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
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
—
0400617
—
IA
05
—
0400618
—
IA
05
—
0400619
—
IA
05
—
0400620
—
IA
05
—
0400621
—
IA
05
—
0402652
—
IA
05
—
0402653
—
IA
05
—
0741769
—
IA
05
—
0748996
—
IA
05
—
1741769
—
IA
05
—
1748996
—
IA
05
—
2741769
—
IA
05
—
2748996
—
IA
05
—
3741769
—
IA
05
—
4741769
—
IA
05
—
5741769
—
IA
05
—
6741769
—
IA
05
—
7741769
—
IA
05
—
8741769
—
IA
05
—
9741769
—
IA
Enumeration date
03/23/2007
Last updated
05/05/2010
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