Provider Demographics
NPI:1235513805
Name:GENERATION SOLUTIONS PERSONAL CARE OF ROANOKE LLC
Entity Type:Organization
Organization Name:GENERATION SOLUTIONS PERSONAL CARE OF ROANOKE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:EVERETTE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-455-6500
Mailing Address - Street 1:3825 ELECTRIC RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4561
Mailing Address - Country:US
Mailing Address - Phone:540-776-3622
Mailing Address - Fax:540-776-0694
Practice Address - Street 1:3825 ELECTRIC RD
Practice Address - Street 2:SUITE A
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-4561
Practice Address - Country:US
Practice Address - Phone:540-776-3622
Practice Address - Fax:540-776-0694
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERATIONS SOLUTIONS HOLDING, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO15898253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAHCO15898OtherHOME CARE LICENSE