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General NPI Number Information
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NPI Number | 1649086240
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Entity Type | Organization
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Legal Business Name | GENERATIONS CLUB
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Dates
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Enumeration Date | 12/09/2024
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 6800 N DALE MABRY HWY STE 222
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City | TAMPA
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State | FL
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Zip | 33614-3984
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Country | US
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Telephone | 813-565-7611
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Fax |
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Provider Business Mailing Address
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Address Line | 6800 N DALE MABRY HWY STE 222
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City | TAMPA
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State | FL
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Zip | 33614-3984
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Country | US
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Telephone | 813-565-7611
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KIM KASPER
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Credential |
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Telephone | 813-565-7611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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