Provider Demographics
NPI:1871038828
Name:DIS-GENERATION GROUP INC.
Entity Type:Organization
Organization Name:DIS-GENERATION GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:IFEANYI
Authorized Official - Last Name:IWUCHUKWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-443-7434
Mailing Address - Street 1:9032 PRESTWICK PKWY N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-3946
Mailing Address - Country:US
Mailing Address - Phone:763-232-1747
Mailing Address - Fax:763-315-3020
Practice Address - Street 1:6617 QUEBEC AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55428-2234
Practice Address - Country:US
Practice Address - Phone:763-232-1747
Practice Address - Fax:763-315-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN379622251E00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health