# GENERATIONAL COMPANION CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255099636
- **Authorized official:** GWENDOLYN BACON FAIRBANKS (OWNER)
- **Authorized official phone:** (904) 537-6722

## Contact information

- **Practice address:** 3571 RAIN FOREST DR W, JACKSONVILLE, FL 32277-9320
- **Practice address phone:** (904) 537-6722
- **Mailing address:** 3571 RAIN FOREST DR W, JACKSONVILLE, FL 32277-9320
- **Mailing address phone:** (904) 537-6722

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |
| 374U00000X | Home Health Aide | — | NULL | — |
| 374U00000X | Home Health Aide | — | — | — |
| 376J00000X | Homemaker | — | NULL | — |
| 376J00000X | Homemaker | — | — | — |

## Other

- **Enumeration date:** 12/02/2021
- **Last updated:** 12/02/2021