Provider Demographics
NPI:1679728299
Name:SECOND GENERATION, INC.
Entity Type:Organization
Organization Name:SECOND GENERATION, INC.
Other - Org Name:AJO TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:HUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-387-6559
Mailing Address - Street 1:1248 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:AJO
Mailing Address - State:AZ
Mailing Address - Zip Code:85321-1602
Mailing Address - Country:US
Mailing Address - Phone:520-387-6559
Mailing Address - Fax:520-387-3933
Practice Address - Street 1:1248 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:AJO
Practice Address - State:AZ
Practice Address - Zip Code:85321-1602
Practice Address - Country:US
Practice Address - Phone:520-387-6559
Practice Address - Fax:520-387-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07648596R343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)