Organization
GENERATION 5 HEALTHCARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. NICOLE TYSON-FERGUSON BSN, RN, CM/DN (CHIEF EXECUTIVE OFFICER)
(443) 824-0966
Entity
Organization
Contact information
Practice address
707 BELGIAN AVE., BALTIMORE, MD 21218
(443) 824-0966
Mailing address
P.O. BOX 43, WHITE MARSH, MD 21162
(443) 824-0966
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/06/2018
Last updated
03/17/2018
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