MEDICARE: NEW GENERATION THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320700000X	Physical Disabilities Residential Treatment Facility		OK

General Provider Information

NPI Number	:	1376848051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW GENERATION THERAPY, LLC

Provider Business Mailing Address
First Line	:	105 E PEKIN AVE
Second Line	:
City	:	MORRIS
State	:	OK
Zip	:	74445-2233
Country	:	US
Telephone Number	:	918-629-9570
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 E PEKIN AVE
Second Line	:
City	:	MORRIS
State	:	OK
Zip	:	74445-2233
Country	:	US
Telephone Number	:	918-629-9570
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DONNA SUE MORGAN
Credential	:
Telephone Number	:	918-629-9570

Provider Enumeration Date	:	01/11/2011
Last Update Date	:	01/11/2011

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