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Organization
PRIME GENERATION
Active
Organization
PRIME GENERATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. STEPHEN WASHINGTON WASHINGTON (PROGRAM DIRECTOR)
(704) 516-7190
Entity
Organization
Contact information
Practice address
2642 FORBES RD, GASTONIA, NC 28056-5206
(704) 516-7190
(704) 516-7190
Mailing address
10540 ENGLISH SETTER WAY, CHARLOTTE, NC 28269-1356
(704) 516-7190
(704) 516-7190
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
07/01/2026
Last updated
07/01/2026
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