Generational Companion Care LLC

Key facts

NPI

1255099636

Entity type

Organization (NPI type 2)

Primary specialty

In Home Supportive Care Agency 253Z00000X

Legal business name

GENERATIONAL COMPANION CARE LLC

Practice address

3571 Rain Forest Dr W
Jacksonville, FL 32277-9320

Phone

(904) 537-6722

NPI assigned

Dec 2, 2021

Organization subpart

No

Authorized official

Name

Gwendolyn Bacon Fairbanks

Title

Owner

Phone

(904) 537-6722

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 2, 2021.

{
    "created_epoch": "1638403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638403200000",
    "number": "1255099636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3571 RAIN FOREST DR W",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322779320",
            "telephone_number": "904-537-6722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3571 RAIN FOREST DR W",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322779320",
            "telephone_number": "904-537-6722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENERATIONAL COMPANION CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-02",
        "last_updated": "2021-12-02",
        "certification_date": "2021-12-02",
        "status": "A",
        "authorized_official_last_name": "BACON FAIRBANKS",
        "authorized_official_first_name": "GWENDOLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-537-6722"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Homemaker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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