1982768586 NPI number — GENERATIONS R.C., INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982768586 NPI number — GENERATIONS R.C., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENERATIONS R.C., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHYSICAL THERAPY OF MILTON
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982768586
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 687
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENUP
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41144-0687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-473-1080
Provider Business Mailing Address Fax Number:
606-473-5875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1509 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MILTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25541-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-743-6995
Provider Business Practice Location Address Fax Number:
304-473-5778
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENTLEY
Authorized Official First Name:
DELORIS
Authorized Official Middle Name:
S
Authorized Official Title or Position:
EXECUTIVE VP - BUSINESS OPERATIONS
Authorized Official Telephone Number:
606-473-1080

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3810000-212 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1707207 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: CN7183 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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