=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790954279
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENERATIONS HEALTH CARE INITIATIVE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2008
-----------------------------------------------------
Last Update Date | 07/15/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 N 3RD AVE W SUITE 310
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-740-6700
-----------------------------------------------------
Fax | 218-740-6710
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 W SUPERIOR ST SUITE 700
-----------------------------------------------------
City | DULUTH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-336-5700
-----------------------------------------------------
Fax | 218-336-5719
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. DANIEL L SVENDSEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 218-336-5702
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 46825
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------