1497896138 NPI number — NEW GENERATION CHURCH/COMMUNITY DEV. CORP

Table of content: (NPI 1497896138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497896138 NPI number — NEW GENERATION CHURCH/COMMUNITY DEV. CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW GENERATION CHURCH/COMMUNITY DEV. CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TENDER LOVE INDEPENDENT HOME CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497896138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 328
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ZEBULON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27597-0328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-553-9251
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
548 JACK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27520-6121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-553-9251
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
919-553-9251

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  MHL-051-129 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7804766 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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