=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114335247
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENERATIONS HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2014
-----------------------------------------------------
Last Update Date | 08/01/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2111 E BASELINE RD
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85283-1516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-595-4663
-----------------------------------------------------
Fax | 866-236-7997
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2111 E BASELINE RD
-----------------------------------------------------
City | TEMPE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85283-1516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-595-4663
-----------------------------------------------------
Fax | 866-236-7997
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. CHERYL L LOVELL
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 602-595-4663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 0000001
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------