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Organization
GENERATION GERANNAMO
Active
Organization
GENERATION GERANNAMO
Active
Other names
Generation Gerannamo inc.
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANTOINETTE JORDAN MS, MED (CEO)
(267) 789-5106
Entity
Organization
Contact information
Practice address
119 THOMAS ST, BRENTWOOD, NY 11717-1218
(267) 789-5106
Mailing address
119 THOMAS ST, BRENTWOOD, NY 11717-1218
(267) 789-5106
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1659874915
CARE MANAGEMENT
FL
05
—
1659874915
—
NY
Enumeration date
09/16/2019
Last updated
09/16/2019
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