Provider Demographics
NPI:1902792013
Name:GENERATIONAL GRACE
Entity type:Organization
Organization Name:GENERATIONAL GRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-906-2991
Mailing Address - Street 1:971 US HIGHWAY 202 N STE R
Mailing Address - Street 2:
Mailing Address - City:BRANCHBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3757
Mailing Address - Country:US
Mailing Address - Phone:732-365-8300
Mailing Address - Fax:856-379-3440
Practice Address - Street 1:971 US HIGHWAY 202 N STE R
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3757
Practice Address - Country:US
Practice Address - Phone:732-365-8300
Practice Address - Fax:856-379-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health