Organization
GENERATION GERANNAMO INC
Active
Organization
GENERATION GERANNAMO INC
Active
Other names
GENERATION GERANNAMO
Organization subpart
No
Provider details
NPI number
Authorized official
ANTOINETTE JORDAN MS, MED, LBS (CEO)
(267) 789-5106
Entity
Organization
Contact information
Practice address
233 KINGSTON RD, UPPER DARBY, PA 19082-3906
(267) 789-5106
Mailing address
233 KINGSTON RD, UPPER DARBY, PA 19082-3906
(267) 789-5106
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
252Y00000X
Early Intervention Provider Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
11/08/2023
Last updated
11/12/2023
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