Provider Demographics
NPI:1619964970
Name:GENERATIONS OF RED BAY, LLC
Entity Type:Organization
Organization Name:GENERATIONS OF RED BAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-545-8444
Mailing Address - Street 1:106 10TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:RED BAY
Mailing Address - State:AL
Mailing Address - Zip Code:35582-3800
Mailing Address - Country:US
Mailing Address - Phone:256-356-4982
Mailing Address - Fax:256-356-8400
Practice Address - Street 1:106 10TH AVE NW
Practice Address - Street 2:
Practice Address - City:RED BAY
Practice Address - State:AL
Practice Address - Zip Code:35582-3800
Practice Address - Country:US
Practice Address - Phone:256-356-4982
Practice Address - Fax:256-356-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10989314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10989OtherSTATE LICENSE NUMBER
AL4754080SMedicaid
AL015201Medicare Oscar/Certification
015201Medicare PIN