Healthcare Provider Details

I. General information

NPI: 1083776769
Provider Name (Legal Business Name): GENERATIONS R.C., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 TEAYS VALLEY ROAD SUITE 100
HURRICANE WV
25526
US

IV. Provider business mailing address

P.O. BOX 219
MILTON WV
25541
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-2500
  • Fax: 304-757-2586
Mailing address:
  • Phone: 304-743-4954
  • Fax: 304-743-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRENDA LYNN TARR
Title or Position: CFO
Credential: CFO
Phone: 304-743-4954