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General NPI Number Information
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NPI Number | 1699300319
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Entity Type | Organization
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Legal Business Name | GENERATIONS BEHAVIORAL HEALTH CLINIC, LLC
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Dates
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Enumeration Date | 03/04/2020
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 16 COLONIAL DR
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City | YOUNGSTOWN
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State | OH
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Zip | 44505-2137
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Country | US
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Telephone | 234-232-7500
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Fax | 234-232-7072
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Provider Business Mailing Address
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Address Line | 196 COLONIAL DR
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City | YOUNGSTOWN
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State | OH
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Zip | 44505-2139
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Country | US
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Telephone | 234-232-7500
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Fax | 234-232-7072
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Authorized Official
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Title or Position | CEO
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Name | ROXANNE JIVIDEN
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Credential |
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Telephone | 234-232-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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