NPIMap

Organization Active NPI

Generations Behavioral Health Clinic, LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Youngstown, OH
National Provider Identifier
1699300319
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
GENERATIONS BEHAVIORAL HEALTH CLINIC, LLC
Practice address
16 Colonial Dr
Youngstown, OH 44505-2137
Phone
(234) 232-7500
Fax
(234) 232-7072
NPI assigned
Mar 4, 2020
Last updated
Mar 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Roxanne Jividen
Title
Ceo
Phone
(234) 232-7500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

16 Colonial Dr
Youngstown, OH 44505-2137

Mailing address

196 Colonial Dr
Youngstown, OH 44505-2139
Phone (234) 232-7500

Other practice location 1

26600 Renaissance Pkwy
Warrensville Heights, OH 44128-5795
Phone (216) 329-8999

Other identifiers 1

IdentifierTypeStateIssuer
0394177MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201006002578 OH Part B Supplier - Clinic/Group Practice 5991124273 Receives reassigned benefits from 22 practitioners
Practice locations: Youngstown, OH

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D2319100Generations Behavioral Health Clinic, LLC16 Colonial Drive, Youngstown, OH 44505Certificate of waiverFeb 23, 2027

National Provider Directory

National Provider Directory

Locations

26600 Renaissance Pkwy
Warrensville Heights, OH 44128
Phone (216) 329-8990

16 Colonial Dr
Youngstown, OH 44505
Phone (234) 232-7478

Practitioners & affiliated clinicians

Practitioners 51

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 51

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616457600000",
    "number": "1699300319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "196 COLONIAL DR",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445052139",
            "telephone_number": "234-232-7500",
            "fax_number": "234-232-7072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 COLONIAL DR",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445052137",
            "telephone_number": "234-232-7500",
            "fax_number": "234-232-7072"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "26600 Renaissance Pkwy",
            "address_purpose": "LOCATION",
            "city": "Warrensville Heights",
            "state": "OH",
            "postal_code": "441285795",
            "country_code": "US",
            "telephone_number": "216-329-8999",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GENERATIONS BEHAVIORAL HEALTH CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-04",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A",
        "authorized_official_last_name": "JIVIDEN",
        "authorized_official_first_name": "ROXANNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "234-232-7500"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0394177",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.