Provider Demographics
NPI:1023831344
Name:GENERATIONS OF GRACE
Entity type:Organization
Organization Name:GENERATIONS OF GRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER / PEER SUPPORT SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:BRONSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-595-0248
Mailing Address - Street 1:2070 N BROADWAY UNIT 5415
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-2057
Mailing Address - Country:US
Mailing Address - Phone:310-595-0248
Mailing Address - Fax:
Practice Address - Street 1:1800 SUTTER ST STE 500
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2587
Practice Address - Country:US
Practice Address - Phone:310-595-0248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty