Provider Demographics
NPI:1528728268
Name:GENERATIONS CHILD & MEMORY CARE LLC
Entity type:Organization
Organization Name:GENERATIONS CHILD & MEMORY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNSOLUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-720-2461
Mailing Address - Street 1:3631 HOFFMAN RD
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-5816
Mailing Address - Country:US
Mailing Address - Phone:507-720-0644
Mailing Address - Fax:
Practice Address - Street 1:3631 HOFFMAN RD
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5816
Practice Address - Country:US
Practice Address - Phone:507-720-0644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)