# GENERATION 5 HEALTHCARE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588163562
- **Authorized official:** MRS. NICOLE TYSON-FERGUSON BSN, RN, CM/DN (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (443) 824-0966

## Contact information

- **Practice address:** 707 BELGIAN AVE., BALTIMORE, MD 21218
- **Practice address phone:** (443) 824-0966
- **Mailing address:** P.O. BOX 43, WHITE MARSH, MD 21162
- **Mailing address phone:** (443) 824-0966

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 02/06/2018
- **Last updated:** 03/17/2018