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NPI Code Detail

MEDICARE: GENERATIONS BEHAVIORAL HEALTH-GENEVA LLC

MEDICARE: GENERATIONS BEHAVIORAL HEALTH-GENEVA LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1283Q00000XPsychiatric HospitalOH

General Provider Information

NPI Number : 1073906301
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENERATIONS BEHAVIORAL HEALTH-GENEVA LLC
Provider Business Mailing Address
First Line : 60 WEST ST
Second Line :
City : GENEVA
State : OH
Zip : 44041-9723
Country : US
Telephone Number : 440-415-0794
Fax Number :
Provider Business Practice Location Address
First Line : 60 WEST ST
Second Line :
City : GENEVA
State : OH
Zip : 44041-9723
Country : US
Telephone Number : 440-415-0794
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : MR. EDWARD ARDELL STACK
Credential :
Telephone Number : 615-298-2932
Provider Enumeration Date : 03/11/2015
Last Update Date : 03/11/2015

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Directions to “GENERATIONS BEHAVIORAL HEALTH-GENEVA LLC ” Practice Location

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