Provider Demographics
NPI:1144556978
Name:GENERATIONS ASSISTED LIVING AND WELLNESS INC
Entity type:Organization
Organization Name:GENERATIONS ASSISTED LIVING AND WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:208-687-0495
Mailing Address - Street 1:13400 N MEYER RD
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-7099
Mailing Address - Country:US
Mailing Address - Phone:208-687-0495
Mailing Address - Fax:208-687-3333
Practice Address - Street 1:13400 N MEYER RD
Practice Address - Street 2:
Practice Address - City:RATHDRUM
Practice Address - State:ID
Practice Address - Zip Code:83858-7099
Practice Address - Country:US
Practice Address - Phone:208-687-0495
Practice Address - Fax:208-687-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRC-826310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807222300Medicaid