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NPI Code Detail

MEDICARE: GENERATIONS BEHAVIORAL HEALTH CLINIC, LLC

MEDICARE: GENERATIONS BEHAVIORAL HEALTH CLINIC, 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1699300319
Entity Type Code : Organization
Provider Name (Legal Business Name) : GENERATIONS BEHAVIORAL HEALTH CLINIC, LLC
Provider Business Mailing Address
First Line : 196 COLONIAL DR
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44505-2139
Country : US
Telephone Number : 234-232-7500
Fax Number : 234-232-7072
Provider Business Practice Location Address
First Line : 16 COLONIAL DR
Second Line :
City : YOUNGSTOWN
State : OH
Zip : 44505-2137
Country : US
Telephone Number : 234-232-7500
Fax Number : 234-232-7072
Authorized Official
Title or Position : CEO
Name : ROXANNE JIVIDEN
Credential :
Telephone Number : 234-232-7500
Provider Enumeration Date : 03/04/2020
Last Update Date : 03/23/2021

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