Healthcare Provider Details

I. General information

NPI: 1891411518
Provider Name (Legal Business Name): GENERATIONS REHAB GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 JACKSON ST
LONACONING MD
21539-1307
US

IV. Provider business mailing address

57 JACKSON ST
LONACONING MD
21539-1307
US

V. Phone/Fax

Practice location:
  • Phone: 301-463-5451
  • Fax: 301-268-5426
Mailing address:
  • Phone: 301-463-5451
  • Fax: 301-268-5426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMES LAUDER
Title or Position: PRESIDENT
Credential: MPT
Phone: 301-268-9995