MEDICARE: GENERATIONS AT HOME 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
1	251E00000X	Home Health Agency	299994364	FL
2	251J00000X	Nursing Care Agency	299994364	FL

General Provider Information

NPI Number	:	1558729426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENERATIONS AT HOME LLC

Provider Business Mailing Address
First Line	:	210 S PINELLAS AVE
Second Line	:	SUITE 158
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-3672
Country	:	US
Telephone Number	:	727-940-3414
Fax Number	:	727-940-3415

Provider Business Practice Location Address
First Line	:	210 S PINELLAS AVE
Second Line	:	SUITE 158
City	:	TARPON SPRINGS
State	:	FL
Zip	:	34689-3672
Country	:	US
Telephone Number	:	727-940-3414
Fax Number	:	727-940-3415

Authorized Official
Title or Position	:	CFO
Name	:	MR. CHRISTOPHER JAMES MOFFATT
Credential	:	R.PH
Telephone Number	:	727-940-3414

Provider Enumeration Date	:	02/05/2016
Last Update Date	:	02/05/2016

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Directions to “GENERATIONS AT HOME LLC ” Practice Location

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