Provider Demographics
NPI:1851652515
Name:GENERATIONS BEHAVIORAL HEALTH - GENEVA LLC
Entity Type:Organization
Organization Name:GENERATIONS BEHAVIORAL HEALTH - GENEVA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WALTON
Authorized Official - Last Name:WARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-751-4762
Mailing Address - Street 1:20600 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 620
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5327
Mailing Address - Country:US
Mailing Address - Phone:216-751-4762
Mailing Address - Fax:
Practice Address - Street 1:60 WEST ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:OH
Practice Address - Zip Code:44041-9723
Practice Address - Country:US
Practice Address - Phone:216-751-4762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHAVIORAL CENTERS OF AMERICA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-30
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000000283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX IDENTIFICATION NUMBER