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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