Provider Demographics
NPI:1669743878
Name:GENERATIONS ON THE BEACH
Entity type:Organization
Organization Name:GENERATIONS ON THE BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CLERC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-610-4636
Mailing Address - Street 1:427 ORIOLE LN
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903-4737
Mailing Address - Country:US
Mailing Address - Phone:321-610-4636
Mailing Address - Fax:321-610-4626
Practice Address - Street 1:427 ORIOLE LN
Practice Address - Street 2:
Practice Address - City:INDIALANTIC
Practice Address - State:FL
Practice Address - Zip Code:32903-4737
Practice Address - Country:US
Practice Address - Phone:321-610-4636
Practice Address - Fax:321-610-4626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL11930310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility