Provider Demographics
NPI:1467865402
Name:GENERATION SENIOR CARE INC.
Entity Type:Organization
Organization Name:GENERATION SENIOR CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ANDREI
Authorized Official - Last Name:KENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-388-4728
Mailing Address - Street 1:17241 RAYMER ST
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:91325-3445
Mailing Address - Country:US
Mailing Address - Phone:818-388-4728
Mailing Address - Fax:818-349-1995
Practice Address - Street 1:9611 CORBIN AVE
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2121
Practice Address - Country:US
Practice Address - Phone:818-388-4728
Practice Address - Fax:818-349-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-07
Last Update Date:2014-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA197608073310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility