Provider Demographics
NPI:1659968436
Name:GENERATIONS PROVIDER CARE SERVICES LLC
Entity Type:Organization
Organization Name:GENERATIONS PROVIDER CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:M
Authorized Official - Last Name:CANTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-746-9046
Mailing Address - Street 1:107 S CHERRY ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:PEARSALL
Mailing Address - State:TX
Mailing Address - Zip Code:78061-2407
Mailing Address - Country:US
Mailing Address - Phone:830-746-9046
Mailing Address - Fax:830-746-9048
Practice Address - Street 1:107 S CHERRY ST UNIT B
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-2407
Practice Address - Country:US
Practice Address - Phone:830-746-9046
Practice Address - Fax:830-746-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health