Provider Demographics
NPI:1538966999
Name:GENERATOR ONE, LLC.
Entity type:Organization
Organization Name:GENERATOR ONE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOROK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-942-8449
Mailing Address - Street 1:8644 STATION ST
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4316
Mailing Address - Country:US
Mailing Address - Phone:440-942-8449
Mailing Address - Fax:
Practice Address - Street 1:8644 STATION ST
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4316
Practice Address - Country:US
Practice Address - Phone:440-942-8449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service