Provider Demographics
NPI:1558703660
Name:GENERATION STATION LLC
Entity Type:Organization
Organization Name:GENERATION STATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MCCROREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-467-6687
Mailing Address - Street 1:545 BECKETT RD
Mailing Address - Street 2:SUITE 105-106
Mailing Address - City:LOGAN TOWNSHIP, (SWEDESBORO)
Mailing Address - State:NJ
Mailing Address - Zip Code:08085
Mailing Address - Country:US
Mailing Address - Phone:856-467-6687
Mailing Address - Fax:856-467-8636
Practice Address - Street 1:545 BECKETT RD
Practice Address - Street 2:SUITE 105-106
Practice Address - City:LOGAN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1547
Practice Address - Country:US
Practice Address - Phone:856-467-6687
Practice Address - Fax:856-467-8636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health