Healthcare Provider Details

I. General information

NPI: 1902792013
Provider Name (Legal Business Name): GENERATIONAL GRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 KENWOOD AVE
CAMDEN NJ
08103
US

IV. Provider business mailing address

2230 RT 70 W STE 2 #1013
CHERRY HILL NJ
08002-3338
US

V. Phone/Fax

Practice location:
  • Phone: 908-758-3576
  • Fax: 888-253-3167
Mailing address:
  • Phone: 908-758-3576
  • Fax: 888-253-3167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TINA D FLAX
Title or Position: ADMINISTRATOR
Credential:
Phone: 856-906-2991