Provider Demographics
NPI:1417563883
Name:HEALTHY GENERATIONS COMPREHENSIVE CARE LLC
Entity Type:Organization
Organization Name:HEALTHY GENERATIONS COMPREHENSIVE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAVON
Authorized Official - Middle Name:TRENICE
Authorized Official - Last Name:DARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CRNP
Authorized Official - Phone:443-961-6164
Mailing Address - Street 1:722 DULANEY VALLEY RD STE 259
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5109
Mailing Address - Country:US
Mailing Address - Phone:443-961-6164
Mailing Address - Fax:
Practice Address - Street 1:7850 ROSSVILLE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-3934
Practice Address - Country:US
Practice Address - Phone:443-961-6164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center