Provider Demographics
NPI:1831249069
Name:NEW GENERATIONS CHILDREN AND FAMILY CENTER INC
Entity type:Organization
Organization Name:NEW GENERATIONS CHILDREN AND FAMILY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-478-9551
Mailing Address - Street 1:1023 YELLOWSTONE AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4478
Mailing Address - Country:US
Mailing Address - Phone:208-478-9551
Mailing Address - Fax:208-478-1507
Practice Address - Street 1:1023 YELLOWSTONE AVE
Practice Address - Street 2:SUITE J
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4478
Practice Address - Country:US
Practice Address - Phone:208-478-9551
Practice Address - Fax:208-478-1507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-253471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1693708Medicare PIN
ID1692649Medicare ID - Type Unspecified