Provider Demographics
NPI:1992027122
Name:GENERATIONS COMMUNITY SERVICE CORPORATION
Entity type:Organization
Organization Name:GENERATIONS COMMUNITY SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-461-0040
Mailing Address - Street 1:2506 MOUNT MORIAH RD STE B-412
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115-1511
Mailing Address - Country:US
Mailing Address - Phone:901-360-0043
Mailing Address - Fax:901-360-0044
Practice Address - Street 1:2506 MOUNT MORIAH RD STE B-412
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115-1511
Practice Address - Country:US
Practice Address - Phone:901-360-0043
Practice Address - Fax:901-360-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN110000301251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health