Provider Demographics
NPI:1255473161
Name:GENERATION CHANGE INC
Entity Type:Organization
Organization Name:GENERATION CHANGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERRY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:HAMRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-756-3425
Mailing Address - Street 1:6619 WICKED OAK LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-8838
Mailing Address - Country:US
Mailing Address - Phone:704-756-3425
Mailing Address - Fax:336-586-7062
Practice Address - Street 1:2100 ELON CT
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244-9771
Practice Address - Country:US
Practice Address - Phone:336-586-7060
Practice Address - Fax:336-586-7062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-001-136322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children