Provider Demographics
NPI:1073500468
Name:GENERATIONS OF VERNON, LLC
Entity Type:Organization
Organization Name:GENERATIONS OF VERNON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-545-8444
Mailing Address - Street 1:1050 CONVALESCENT RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:AL
Mailing Address - Zip Code:35592-4823
Mailing Address - Country:US
Mailing Address - Phone:205-695-9313
Mailing Address - Fax:205-695-9820
Practice Address - Street 1:1050 CONVALESCENT RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:AL
Practice Address - Zip Code:35592-4823
Practice Address - Country:US
Practice Address - Phone:205-695-9313
Practice Address - Fax:205-695-9820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL09682314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4752280SMedicaid
AL510-09170OtherBLUE CROSS BLUE SHIELD
AL4752280SMedicaid