Provider Demographics
NPI:1225512601
Name:GENERATION ABLE
Entity Type:Organization
Organization Name:GENERATION ABLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WOODARD
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:904-415-6748
Mailing Address - Street 1:8100 W ANDERSON MILL RD APT 3102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78729
Mailing Address - Country:US
Mailing Address - Phone:904-415-6748
Mailing Address - Fax:
Practice Address - Street 1:8100 W ANDERSON MILL RD APT 3102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78729
Practice Address - Country:US
Practice Address - Phone:904-415-6748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX251B00000XMedicaid