Healthcare Provider Details

I. General information

NPI: 1578363701
Provider Name (Legal Business Name): GENERATIONS R.C., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MARSHALL ST N STE 2
BENWOOD WV
26031-1041
US

IV. Provider business mailing address

PO BOX 219
MILTON WV
25541-0219
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-2500
  • Fax: 304-757-2586
Mailing address:
  • Phone: 681-233-0753
  • Fax: 304-208-8925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: TERRY MUNDELL
Title or Position: CREDENTAILING AGENT
Credential:
Phone: 681-233-0753