Provider Demographics
NPI:1558729426
Name:GENERATIONS AT HOME LLC
Entity Type:Organization
Organization Name:GENERATIONS AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MOFFATT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:727-940-3414
Mailing Address - Street 1:210 S PINELLAS AVE
Mailing Address - Street 2:SUITE 158
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-3672
Mailing Address - Country:US
Mailing Address - Phone:727-940-3414
Mailing Address - Fax:727-940-3415
Practice Address - Street 1:210 S PINELLAS AVE
Practice Address - Street 2:SUITE 158
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3672
Practice Address - Country:US
Practice Address - Phone:727-940-3414
Practice Address - Fax:727-940-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994364251E00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health