Healthcare Provider Details

I. General information

NPI: 1245074400
Provider Name (Legal Business Name): GENERATION2JENERATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2024
Last Update Date: 06/22/2024
Certification Date: 06/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9209 GRAND DIVISION AVE
CLEVELAND OH
44125-1353
US

IV. Provider business mailing address

9209 GRAND DIVISION AVE
CLEVELAND OH
44125-1353
US

V. Phone/Fax

Practice location:
  • Phone: 440-538-4564
  • Fax:
Mailing address:
  • Phone: 440-538-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State

VIII. Authorized Official

Name: THERESA M SMILEY
Title or Position: OWNER
Credential: CHW
Phone: 440-538-4564