Provider Demographics
NPI:1083776769
Name:GENERATIONS R.C., INC.
Entity Type:Organization
Organization Name:GENERATIONS R.C., INC.
Other - Org Name:GENERATIONS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TARR
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:304-743-4954
Mailing Address - Street 1:P.O. BOX 219
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WV
Mailing Address - Zip Code:25541
Mailing Address - Country:US
Mailing Address - Phone:304-743-4954
Mailing Address - Fax:304-743-0291
Practice Address - Street 1:3705 TEAYS VALLEY ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526
Practice Address - Country:US
Practice Address - Phone:304-757-2500
Practice Address - Fax:304-757-2586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000-212Medicaid
WV1707207OtherBLUE CROSS BLUE SHIELD
WVGE9292443Medicare ID - Type UnspecifiedBARBOURSVILLE, WV CLINIC
WVGE9292442Medicare ID - Type UnspecifiedMILTON, WV CLINIC
WV1707207OtherBLUE CROSS BLUE SHIELD
WVGE9292441Medicare ID - Type UnspecifiedHURRICANE, WV CLINIC
WVGE9292442Medicare ID - Type UnspecifiedMILTON, WV CLINIC
WV1707207OtherBLUE CROSS BLUE SHIELD
WV=========OtherCIGNA
WV3810000-212Medicaid
WVGE9292443Medicare ID - Type UnspecifiedBARBOURSVILLE, WV CLINIC