Healthcare Provider Details

I. General information

NPI: 1356014674
Provider Name (Legal Business Name): GENERATIONS PLUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2021
Last Update Date: 09/06/2021
Certification Date: 09/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 NW 79TH AVE STE 245
DORAL FL
33166-6506
US

IV. Provider business mailing address

PO BOX 882212
PORT ST LUCIE FL
34988-2212
US

V. Phone/Fax

Practice location:
  • Phone: 772-494-1321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LENTZ DORCELY
Title or Position: ADMINISTRATOR
Credential: DRPH,MPH
Phone: 954-740-3814