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NPI Code Detail

MEDICARE: GENERATIONS BEHAVIORAL HEALTH, YOUNGSTOWN, LLC

MEDICARE: GENERATIONS BEHAVIORAL HEALTH, YOUNGSTOWN, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1588295166
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENERATIONS BEHAVIORAL HEALTH, YOUNGSTOWN, LLC
Provider Business Mailing Address
First Line : 196 COLONIAL DR
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44505-2139
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 196 COLONIAL DR
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44505-2139
Country : US
Telephone Number : 234-232-7500
Fax Number :
Authorized Official
Title or Position : CREDENTIALING
Name : ANNA SANTANGELO
Credential :
Telephone Number : 234-232-7500
Provider Enumeration Date : 01/31/2020
Last Update Date : 01/31/2020

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