Provider Demographics
NPI:1952480691
Name:GENERATIONS HOME HEALTH AGENCY
Entity Type:Organization
Organization Name:GENERATIONS HOME HEALTH AGENCY
Other - Org Name:GENERATIONS HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF OPERATIONS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-652-0750
Mailing Address - Street 1:8601 SE CAUSEY AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086
Mailing Address - Country:US
Mailing Address - Phone:503-652-0753
Mailing Address - Fax:503-654-5132
Practice Address - Street 1:8601 SE CAUSEY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-9755
Practice Address - Country:US
Practice Address - Phone:503-652-0753
Practice Address - Fax:503-654-5132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR131336251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR207662Medicaid
OR207662Medicaid