Provider Demographics
NPI:1245074400
Name:GENERATION2JENERATION
Entity type:Organization
Organization Name:GENERATION2JENERATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMILEY
Authorized Official - Suffix:
Authorized Official - Credentials:CHW
Authorized Official - Phone:440-538-4564
Mailing Address - Street 1:9209 GRAND DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44125-1353
Mailing Address - Country:US
Mailing Address - Phone:440-538-4564
Mailing Address - Fax:
Practice Address - Street 1:9209 GRAND DIVISION AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-1353
Practice Address - Country:US
Practice Address - Phone:440-538-4564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No385HR2050XRespite Care FacilityRespite CareRespite Care Camp