Healthcare Provider Details

I. General information

NPI: 1619964970
Provider Name (Legal Business Name): GENERATIONS OF RED BAY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 10TH AVE NW
RED BAY AL
35582-3800
US

IV. Provider business mailing address

106 10TH AVE NW
RED BAY AL
35582-3800
US

V. Phone/Fax

Practice location:
  • Phone: 256-356-4982
  • Fax: 256-356-8400
Mailing address:
  • Phone: 256-356-4982
  • Fax: 256-356-8400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10989
License Number StateAL

VIII. Authorized Official

Name: MR. JOHN ERIC MELTON
Title or Position: MEMBER/CFO
Credential:
Phone: 205-545-8444