Basic Information
| Provider Information | |||||||||
| NPI: | 1851652515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GENERATIONS BEHAVIORAL HEALTH - GENEVA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20600 CHAGRIN BLVD | ||||||||
| Address2: | SUITE 620 | ||||||||
| City: | SHAKER HEIGHTS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441225327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167514762 | ||||||||
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| Practice Location | |||||||||
| Address1: | 60 WEST ST | ||||||||
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| City: | GENEVA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440419723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2167514762 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2012 | ||||||||
| LastUpdateDate: | 09/05/2012 | ||||||||
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| AuthorizedOfficialLastName: | WARDEN | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | WALTON | ||||||||
| AuthorizedOfficialTitleorPosition: | HOSPITAL ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2167514762 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BEHAVIORAL CENTERS OF AMERICA | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283Q00000X | 000000 | OH | Y | Hospitals | Psychiatric Hospital |
No ID Information.