Provider Demographics
NPI:1497896138
Name:NEW GENERATION CHURCH/COMMUNITY DEV. CORP
Entity Type:Organization
Organization Name:NEW GENERATION CHURCH/COMMUNITY DEV. CORP
Other - Org Name:TENDER LOVE INDEPENDENT HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-553-9251
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-0328
Mailing Address - Country:US
Mailing Address - Phone:919-553-9251
Mailing Address - Fax:
Practice Address - Street 1:548 JACK RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-6121
Practice Address - Country:US
Practice Address - Phone:919-553-9251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-051-129320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7804766Medicaid