Healthcare Provider Details

I. General information

NPI: 1689104549
Provider Name (Legal Business Name): GENERATIONS ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E BROADWAY
MONTICELLO NY
12701-8815
US

IV. Provider business mailing address

PO BOX 127
LIBERTY NY
12754-0127
US

V. Phone/Fax

Practice location:
  • Phone: 845-292-0000
  • Fax:
Mailing address:
  • Phone: 914-799-4557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SERGIO A SARAVIA
Title or Position: ATTORNEY
Credential:
Phone: 845-292-0000