Provider Demographics
NPI:1457770661
Name:GENERATIONS GROUP HOMES OF GREENVILLE, INC
Entity Type:Organization
Organization Name:GENERATIONS GROUP HOMES OF GREENVILLE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPCS
Authorized Official - Phone:864-243-5557
Mailing Address - Street 1:PO BOX 80009
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-0001
Mailing Address - Country:US
Mailing Address - Phone:864-243-5557
Mailing Address - Fax:864-243-3339
Practice Address - Street 1:820 DUNKLIN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN INN
Practice Address - State:SC
Practice Address - Zip Code:29644-9725
Practice Address - Country:US
Practice Address - Phone:864-243-5557
Practice Address - Fax:864-243-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health