Provider Demographics
NPI:1790954279
Name:GENERATIONS HEALTH CARE INITIATIVE INC
Entity Type:Organization
Organization Name:GENERATIONS HEALTH CARE INITIATIVE INC
Other - Org Name:FETAL ALCOHOL DIAGNOSTIC PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:SVENDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-336-5702
Mailing Address - Street 1:130 W SUPERIOR ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802
Mailing Address - Country:US
Mailing Address - Phone:218-336-5700
Mailing Address - Fax:218-336-5719
Practice Address - Street 1:5 N 3RD AVE W
Practice Address - Street 2:SUITE 310
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802
Practice Address - Country:US
Practice Address - Phone:218-740-6700
Practice Address - Fax:218-740-6710
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERATIONS HEALTH CARE INITIATIVE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-28
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46825174400000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty