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General NPI Number Information
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NPI Number | 1588456420
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Entity Type | Organization
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Legal Business Name | NEXGEN MENTORS LLC
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 11/29/2025
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Provider Practice Location Address
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Address Line | 1467 N MAIN ST STE C
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City | DANVILLE
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State | VA
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Zip | 24540-3755
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Country | US
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Telephone | 919-407-8696
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Fax |
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Provider Business Mailing Address
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Address Line | 1412 MILTON HWY
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City | RINGGOLD
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State | VA
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Zip | 24586-2945
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Country | US
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Telephone | 434-709-3581
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. RONNIE LEE GLASS JR.
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Credential |
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Telephone | 434-709-3581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174200000X
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Taxonomy Name | Meals Provider
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251X00000X
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Taxonomy Name | Supports Brokerage Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 347E00000X
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Taxonomy Name | Transportation Broker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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