MEDICARE: NEW GENERATIONS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility		NC

General Provider Information

NPI Number	:	1962647040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW GENERATIONS INC.

Provider Business Mailing Address
First Line	:	PO BOX 722
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28151-0722
Country	:	US
Telephone Number	:
Fax Number	:	704-480-9892

Provider Business Practice Location Address
First Line	:	170 TINEY RD
Second Line	:
City	:	ELLENBORO
State	:	NC
Zip	:	28040-7608
Country	:	US
Telephone Number	:	704-466-1003
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. JODI MARIE SHADE
Credential	:
Telephone Number	:	704-524-7209

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	03/17/2009

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