Provider Demographics
NPI:1932866134
Name:GENEROSO HEALTH LLC
Entity Type:Organization
Organization Name:GENEROSO HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARVI
Authorized Official - Middle Name:MALLARI
Authorized Official - Last Name:GENEROSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-800-9480
Mailing Address - Street 1:PO BOX 1163
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:WA
Mailing Address - Zip Code:98611-1163
Mailing Address - Country:US
Mailing Address - Phone:360-800-9480
Mailing Address - Fax:
Practice Address - Street 1:23 COWLITZ W
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:WA
Practice Address - Zip Code:98611
Practice Address - Country:US
Practice Address - Phone:872-395-1626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-22
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center