Provider Demographics
NPI:1447640784
Name:GENERATIONAL HEALTHCARE LLC
Entity type:Organization
Organization Name:GENERATIONAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FROGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-726-2338
Mailing Address - Street 1:1264 W VILLAGE MAIN DR
Mailing Address - Street 2:STE A
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-3396
Mailing Address - Country:US
Mailing Address - Phone:801-972-0393
Mailing Address - Fax:801-972-5707
Practice Address - Street 1:1264 W VILLAGE MAIN DR
Practice Address - Street 2:STE A
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-3396
Practice Address - Country:US
Practice Address - Phone:801-972-0393
Practice Address - Fax:801-972-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5356508-1205207Q00000X
UT6344620-1206208100000X
208100000X, 2081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty