Healthcare Provider Details

I. General information

NPI: 1023432911
Provider Name (Legal Business Name): GENERATIONS HEALTH SYSTEMS OF MATTHEWS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 S RAILROAD
MATTHEWS MO
63867-9751
US

IV. Provider business mailing address

17826 EDISON AVE
CHESTERFIELD MO
63005-1262
US

V. Phone/Fax

Practice location:
  • Phone: 573-471-7861
  • Fax: 573-471-9527
Mailing address:
  • Phone: 636-536-5365
  • Fax: 636-536-4533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. JOHN M SELLS
Title or Position: MANAGER
Credential:
Phone: 636-536-5365