Provider Demographics
NPI:1417659418
Name:GENERATIONS SG ENTERPRISE
Entity Type:Organization
Organization Name:GENERATIONS SG ENTERPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMELIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-873-7753
Mailing Address - Street 1:8826 SAN MARCO BLVD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-4864
Mailing Address - Country:US
Mailing Address - Phone:586-873-7753
Mailing Address - Fax:
Practice Address - Street 1:18949 PEMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:MI
Practice Address - Zip Code:48042-6308
Practice Address - Country:US
Practice Address - Phone:586-873-7753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)