Provider Demographics
NPI:1912291683
Name:SECOND GEN VENTURES INCORPORATED
Entity Type:Organization
Organization Name:SECOND GEN VENTURES INCORPORATED
Other - Org Name:GEORGETOWN LIVING HOME HEALTH & COMPANIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHAR
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-843-0117
Mailing Address - Street 1:2700 SHELL RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-9237
Mailing Address - Country:US
Mailing Address - Phone:512-843-0117
Mailing Address - Fax:512-863-8222
Practice Address - Street 1:2700 SHELL RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-9237
Practice Address - Country:US
Practice Address - Phone:512-843-0117
Practice Address - Fax:512-863-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-31
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX747887OtherMEDICARE PTAN