Organization Name: | GENERATIONS COMMUNITY SUPPORT SERVICE |
NPI Number: | 1861440919 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KATHLEEN JOAN GORMAN (PRESIDENT) |
Mailing Address: | 60 E Marie St #117 W St Paul |
State: | MN US |
Postal Code: | 55118 |
Phone Number: | 6126761604 |
Fax Number: | 6515529874 |
NPI Enumeration Date: | 05/04/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |