Provider Demographics
NPI:1215591474
Name:GENERATIONS EMPOWERED, INC
Entity Type:Organization
Organization Name:GENERATIONS EMPOWERED, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAYAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-308-0453
Mailing Address - Street 1:485 FOXBOROUGH TRL
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4835
Mailing Address - Country:US
Mailing Address - Phone:708-738-7038
Mailing Address - Fax:
Practice Address - Street 1:2835 N SHEFFIELD AVE STE 407
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-5084
Practice Address - Country:US
Practice Address - Phone:773-789-8034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL001Medicaid