Provider Demographics
NPI:1891411518
Name:GENERATIONS REHAB GROUP, LLC
Entity Type:Organization
Organization Name:GENERATIONS REHAB GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUDER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:301-268-9995
Mailing Address - Street 1:57 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:LONACONING
Mailing Address - State:MD
Mailing Address - Zip Code:21539-1307
Mailing Address - Country:US
Mailing Address - Phone:301-463-5451
Mailing Address - Fax:301-268-5426
Practice Address - Street 1:57 JACKSON ST
Practice Address - Street 2:
Practice Address - City:LONACONING
Practice Address - State:MD
Practice Address - Zip Code:21539-1307
Practice Address - Country:US
Practice Address - Phone:301-463-5451
Practice Address - Fax:301-268-5426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1346588829Medicaid
MD1629102561Medicaid
MD1003261850Medicaid
MD1568813889Medicaid