1790954279 NPI number — GENERATIONS HEALTH CARE INITIATIVE INC

Table of content: (NPI 1790954279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790954279 NPI number — GENERATIONS HEALTH CARE INITIATIVE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENERATIONS HEALTH CARE INITIATIVE 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:
Provider Other Organization Name Type Code:
6
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:
1790954279
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 W SUPERIOR ST
Provider Second Line Business Mailing Address:
SUITE 700
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-336-5700
Provider Business Mailing Address Fax Number:
218-336-5719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 N 3RD AVE W
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-740-6700
Provider Business Practice Location Address Fax Number:
218-740-6710
Provider Enumeration Date:
02/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SVENDSEN
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
218-336-5702

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  46825 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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