Provider Demographics
NPI:1689185159
Name:NEXTGEN TREATMENT, INC.
Entity Type:Organization
Organization Name:NEXTGEN TREATMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BALKCOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-268-8607
Mailing Address - Street 1:9880 N MAGNOLIA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-1901
Mailing Address - Country:US
Mailing Address - Phone:619-916-3177
Mailing Address - Fax:619-757-2328
Practice Address - Street 1:2026 N IMPERIAL AVE STE D
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-1607
Practice Address - Country:US
Practice Address - Phone:760-693-5372
Practice Address - Fax:760-693-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty