Provider Demographics
NPI:1053066795
Name:FIRST GENERATION CARE MYRTLE BEACH LLC
Entity Type:Organization
Organization Name:FIRST GENERATION CARE MYRTLE BEACH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:ASLLANAJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-222-0358
Mailing Address - Street 1:2600 N KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-3035
Mailing Address - Country:US
Mailing Address - Phone:843-222-0358
Mailing Address - Fax:
Practice Address - Street 1:2600 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-3035
Practice Address - Country:US
Practice Address - Phone:843-222-0358
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care