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General NPI Number Information
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NPI Number | 1407773401
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Entity Type | Organization
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Legal Business Name | PRIME GENERATION
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Dates
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Enumeration Date | 07/01/2026
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Last Update Date | 07/01/2026
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Provider Practice Location Address
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Address Line | 2642 FORBES RD
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City | GASTONIA
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State | NC
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Zip | 28056-5206
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Country | US
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Telephone | 704-516-7190
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Fax | 704-516-7190
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Provider Business Mailing Address
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Address Line | 10540 ENGLISH SETTER WAY
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City | CHARLOTTE
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State | NC
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Zip | 28269-1356
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Country | US
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Telephone | 704-516-7190
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Fax | 704-516-7190
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. STEPHEN WASHINGTON
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Credential | WASHINGTON
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Telephone | 704-516-7190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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