Provider Demographics
NPI:1083940852
Name:THE COMMUNITY TRUST CORPORATION
Entity Type:Organization
Organization Name:THE COMMUNITY TRUST CORPORATION
Other - Org Name:GENERATIONS BEHAVIORAL HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-222-0046
Mailing Address - Street 1:1677 MAHAN CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5454
Mailing Address - Country:US
Mailing Address - Phone:850-222-0046
Mailing Address - Fax:850-222-0063
Practice Address - Street 1:1677 MAHAN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5454
Practice Address - Country:US
Practice Address - Phone:850-222-0046
Practice Address - Fax:850-222-0063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
169341349OtherDUNS