Healthcare Provider Details

I. General information

NPI: 1912635624
Provider Name (Legal Business Name): GEN NEXT ENTERPRISES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 E EBONY PL
CHANDLER AZ
85286-2236
US

IV. Provider business mailing address

1602 E EBONY PL
CHANDLER AZ
85286-2236
US

V. Phone/Fax

Practice location:
  • Phone: 520-471-6935
  • Fax:
Mailing address:
  • Phone: 520-471-6935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: CHARLES NASH
Title or Position: ALT ADMIN
Credential:
Phone: 520-471-6935