1083776769 NPI number — GENERATIONS R.C., INC.

Table of content: (NPI 1083776769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083776769 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:
GENERATIONS PHYSICAL THERAPY
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:
1083776769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 219
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-743-4954
Provider Business Mailing Address Fax Number:
304-743-0291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3705 TEAYS VALLEY ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HURRICANE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-757-2500
Provider Business Practice Location Address Fax Number:
304-757-2586
Provider Enumeration Date:
12/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TARR
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
304-743-4954

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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".




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