Healthcare Provider Details

I. General information

NPI: 1497977870
Provider Name (Legal Business Name): GENERATIONS PLUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 BROWNING RD SUITE 220
PENNSAUKEN NJ
08109-4323
US

IV. Provider business mailing address

7905 BROWNING RD SUITE 220
PENNSAUKEN NJ
08109-4323
US

V. Phone/Fax

Practice location:
  • Phone: 856-317-1910
  • Fax: 856-317-1926
Mailing address:
  • Phone: 856-317-1910
  • Fax: 856-317-1926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number96058109
License Number StateNJ

VIII. Authorized Official

Name: MR. MOSHE CULANG
Title or Position: ADMINSTRATOR
Credential:
Phone: 856-317-1910