Healthcare Provider Details

I. General information

NPI: 1588456420
Provider Name (Legal Business Name): NEXGEN MENTORS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 11/29/2025
Certification Date: 11/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1467 N MAIN ST STE C
DANVILLE VA
24540-3755
US

IV. Provider business mailing address

1412 MILTON HWY
RINGGOLD VA
24586-2945
US

V. Phone/Fax

Practice location:
  • Phone: 919-407-8696
  • Fax:
Mailing address:
  • Phone: 434-709-3581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. RONNIE LEE GLASS JR.
Title or Position: CEO
Credential:
Phone: 434-709-3581