Healthcare Provider Details

I. General information

NPI: 1447908967
Provider Name (Legal Business Name): GENERATIONAL HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 STATE ST STE 6
HACKENSACK NJ
07601-5530
US

IV. Provider business mailing address

354 STATE ST STE 6
HACKENSACK NJ
07601-5530
US

V. Phone/Fax

Practice location:
  • Phone: 973-966-8630
  • Fax:
Mailing address:
  • Phone: 973-966-8630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

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

# 1
IdentifierNONE
Identifier TypeOTHER
Identifier State
Identifier IssuerN/A

VIII. Authorized Official

Name: DEVON LIVINGSTON
Title or Position: PRESIDENT
Credential:
Phone: 973-518-9982