Provider Demographics
NPI:1366504722
Name:E-GENERATION
Entity Type:Organization
Organization Name:E-GENERATION
Other - Org Name:INTEGRATED CARE MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:AINA
Authorized Official - Suffix:
Authorized Official - Credentials:MIS
Authorized Official - Phone:301-386-7888
Mailing Address - Street 1:1400 MERCANTILE LN
Mailing Address - Street 2:#212
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5341
Mailing Address - Country:US
Mailing Address - Phone:301-386-7888
Mailing Address - Fax:301-386-8877
Practice Address - Street 1:1400 MERCANTILE LN
Practice Address - Street 2:#212
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5341
Practice Address - Country:US
Practice Address - Phone:301-386-7888
Practice Address - Fax:301-386-8877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health