Provider Demographics
NPI:1245212380
Name:GENERATIONS HEALTH ASSOCIATION, INC.
Entity Type:Organization
Organization Name:GENERATIONS HEALTH ASSOCIATION, INC.
Other - Org Name:GENERATIONS MENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-507-1212
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:MC MINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37111-0640
Mailing Address - Country:US
Mailing Address - Phone:931-815-1212
Mailing Address - Fax:931-815-1221
Practice Address - Street 1:5736 MANCHESTER HWY
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:TN
Practice Address - Zip Code:37357-7503
Practice Address - Country:US
Practice Address - Phone:931-815-1212
Practice Address - Fax:931-815-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-15
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL2140753006261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3727359Medicaid
TN3727359Medicaid