Provider Demographics
NPI:1578081204
Name:GENERATIONS AT HOME HOLDINGS, LLC
Entity Type:Organization
Organization Name:GENERATIONS AT HOME HOLDINGS, LLC
Other - Org Name:GENERATIONS AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RENZ
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-940-3414
Mailing Address - Street 1:1 BEACH DR SE STE 302
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3963
Mailing Address - Country:US
Mailing Address - Phone:727-940-3414
Mailing Address - Fax:727-940-3415
Practice Address - Street 1:1 BEACH DR SE
Practice Address - Street 2:SUITE 302
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
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:2017-09-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994364253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care