MEDICARE: GENERATIONAL SERVICES 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1750962379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATIONAL SERVICES LLC

Provider Business Mailing Address
First Line	:	7712 SADDLEWOOD DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-3044
Country	:	US
Telephone Number	:	260-572-5095
Fax Number	:

Provider Business Practice Location Address
First Line	:	7712 SADDLEWOOD DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-3044
Country	:	US
Telephone Number	:	260-572-5095
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAMINICA RUFFIN-JONES
Credential	:
Telephone Number	:	260-572-5095

Provider Enumeration Date	:	04/15/2021
Last Update Date	:	04/15/2021

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