MEDICARE: GENERATIONS IN HOME CARE

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
1	253Z00000X	In Home Supportive Care Agency	231601	FL

General Provider Information

NPI Number	:	1609172469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATIONS IN HOME CARE

Provider Business Mailing Address
First Line	:	6155 HIGHWAY 17 S
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-4930
Country	:	US
Telephone Number	:	904-529-7325
Fax Number	:

Provider Business Practice Location Address
First Line	:	6155 HIGHWAY 17 S
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-4930
Country	:	US
Telephone Number	:	904-529-7325
Fax Number	:	904-529-7325

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. DENISE ANN SMITH
Credential	:	R.N.
Telephone Number	:	904-993-8243

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	01/26/2011

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