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General NPI Number Information
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NPI Number | 1417563883
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Entity Type | Organization
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Legal Business Name | HEALTHY GENERATIONS COMPREHENSIVE CARE LLC
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Dates
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Enumeration Date | 09/21/2020
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Last Update Date | 10/05/2020
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Provider Practice Location Address
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Address Line | 7850 ROSSVILLE BLVD STE 210
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City | NOTTINGHAM
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State | MD
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Zip | 21236-3934
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Country | US
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Telephone | 443-961-6164
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Fax |
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Provider Business Mailing Address
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Address Line | 722 DULANEY VALLEY RD STE 259
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City | TOWSON
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State | MD
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Zip | 21204-5109
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Country | US
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Telephone | 443-961-6164
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. SHAVON TRENICE DARDEN
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Credential | PHD, CRNP
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Telephone | 443-961-6164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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