Provider Demographics
NPI:1093099053
Name:GENERATIONS HEALTH ASSOCIATION
Entity Type:Organization
Organization Name:GENERATIONS HEALTH ASSOCIATION
Other - Org Name:GENERATIONS MENTAL HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:FORRESTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:731-588-5829
Mailing Address - Street 1:920 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-1605
Mailing Address - Country:US
Mailing Address - Phone:731-588-5834
Mailing Address - Fax:
Practice Address - Street 1:920 UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-1605
Practice Address - Country:US
Practice Address - Phone:731-588-5834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN62172251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health