1336230713 NPI number — GENERATIONS: COMMUNITY SUPPORT SERVICES

Table of content: (NPI 1336230713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336230713 NPI number — GENERATIONS: COMMUNITY SUPPORT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENERATIONS: COMMUNITY SUPPORT SERVICES
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:
Provider Other Organization Name Type Code:
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:
1336230713
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2649 PARK AVE S.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-676-1604
Provider Business Mailing Address Fax Number:
612-379-8235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 MARIE AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55118-5910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-552-9071
Provider Business Practice Location Address Fax Number:
651-552-9874
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GORMAN
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
JOAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
612-676-1604

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1500 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1534157 00 . This is a "MA - BEKAH SALITERMAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4467043 00 . This is a "MA - JAY THEISEN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5124786 00 . This is a "MA - KARLA MUSSER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8273090 00 . This is a "MA - JOHN LAMPERT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8279578 00 . This is a "MA IN-HOME - GENERATIONS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 9831134 00 . This is a "MA CADI - GENERATIONS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 4724372 00 . This is a "MA - JORDAN HART" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0025101 00 . This is a "MA IN-OFFICE - GENERATION" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1366084 00 . This is a "MA - JENNIFER GERVAIS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 0616371 00 . This is a "MA - KATIE SHAW" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 7126875 00 . This is a "MA - JOY PETERMANN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 7194978 00 . This is a "MA - KATHLEEN GORMAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 7676920 00 . This is a "MA - VESSELA KOUNEVA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 558915 00 . This is a "MA - KIRSTEN JANKOVICH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8226083 00 . This is a "MA - NICOLE HELLAND" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 5041406 00 . This is a "MA - JO MCBRIDE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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