Provider Demographics
NPI:1720678725
Name:GENERATIONS BEHAVIORAL HEALTHCARE, P.C.
Entity Type:Organization
Organization Name:GENERATIONS BEHAVIORAL HEALTHCARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH DALE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RESTOR
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:847-558-9852
Mailing Address - Street 1:15 SPINNING WHEEL RD STE 30
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-7651
Mailing Address - Country:US
Mailing Address - Phone:630-259-1515
Mailing Address - Fax:773-313-3320
Practice Address - Street 1:15 SPINNING WHEEL RD STE 30
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-7651
Practice Address - Country:US
Practice Address - Phone:630-259-1515
Practice Address - Fax:773-313-3320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-22
Last Update Date:2021-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty