Provider Demographics
NPI:1366469231
Name:GENERATIONS HEALTHCARE, LLC
Entity Type:Organization
Organization Name:GENERATIONS HEALTHCARE, LLC
Other - Org Name:GENERATIONS HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT/COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PONAKALA
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:708-409-3040
Mailing Address - Street 1:2 WESTBROOK CORPORATE CTR STE 320
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-5721
Mailing Address - Country:US
Mailing Address - Phone:708-409-3040
Mailing Address - Fax:708-409-3041
Practice Address - Street 1:2 WESTBROOK CORPORATE CTR STE 320
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5721
Practice Address - Country:US
Practice Address - Phone:708-409-3040
Practice Address - Fax:708-409-3041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL502330OtherBLUE CROSS/BLUE SHIELD
IL=========001Medicaid
IL=========001Medicaid