MEDICARE: GENERATIONAL HEALTH, 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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1609620541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATIONAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	3620 N 16TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68110-1818
Country	:	US
Telephone Number	:	402-298-6523
Fax Number	:

Provider Business Practice Location Address
First Line	:	3620 N 16TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68110-1818
Country	:	US
Telephone Number	:	402-298-6523
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANNON LANGFORD
Credential	:
Telephone Number	:	402-298-6523

Provider Enumeration Date	:	04/16/2024
Last Update Date	:	04/16/2024

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Directions to “GENERATIONAL HEALTH, LLC ” Practice Location

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