MEDICARE: GENERATION2JENERATION

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
1	385HR2050X	Respite Care Camp
2	385H00000X	Respite Care

General Provider Information

NPI Number	:	1245074400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATION2JENERATION

Provider Business Mailing Address
First Line	:	9209 GRAND DIVISION AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-1353
Country	:	US
Telephone Number	:	440-538-4564
Fax Number	:

Provider Business Practice Location Address
First Line	:	9209 GRAND DIVISION AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44125-1353
Country	:	US
Telephone Number	:	440-538-4564
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	THERESA M SMILEY
Credential	:	CHW
Telephone Number	:	440-538-4564

Provider Enumeration Date	:	06/22/2024
Last Update Date	:	06/22/2024

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