=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992000517
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEXGEN HOME CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/12/2011
-----------------------------------------------------
Last Update Date | 11/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5165 ESTATE VIEW TRCE
-----------------------------------------------------
City | SUWANEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-480-0234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5165 ESTATE VIEW TRCE
-----------------------------------------------------
City | SUWANEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30024-3410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-480-0234
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | SHARON L LAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-480-0234
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 061-R-0711
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------