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General NPI Number Information
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NPI Number | 1912291683
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Entity Type | Organization
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Legal Business Name | SECOND GEN VENTURES INCORPORATED
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 1508 LEANDER RD # 101
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City | GEORGETOWN
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State | TX
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Zip | 78628-8800
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Country | US
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Telephone | 512-843-0117
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Fax | 512-843-0127
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Provider Business Mailing Address
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Address Line | 2700 SHELL RD
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City | GEORGETOWN
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State | TX
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Zip | 78628-9237
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Country | US
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Telephone | 512-843-0117
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Fax | 512-863-8222
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ERIC CORUM
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Credential |
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Telephone | 512-843-0117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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