Provider Demographics
NPI:1083921308
Name:GENERATIONS GROUP HOMES OF GREENVILLE. INC.
Entity Type:Organization
Organization Name:GENERATIONS GROUP HOMES OF GREENVILLE. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-243-5557
Mailing Address - Street 1:PO BOX 80009
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-0009
Mailing Address - Country:US
Mailing Address - Phone:864-243-5557
Mailing Address - Fax:864-243-5947
Practice Address - Street 1:821 DUNKLIN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN INN
Practice Address - State:SC
Practice Address - Zip Code:29644-9725
Practice Address - Country:US
Practice Address - Phone:864-243-5557
Practice Address - Fax:864-243-5947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health