Provider Demographics
NPI:1285901660
Name:NEXT GENERATION FAMILY AND YOUTH SERVICES LLC
Entity type:Organization
Organization Name:NEXT GENERATION FAMILY AND YOUTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-245-7202
Mailing Address - Street 1:1956 THURGOOD MARSHALL HWY
Mailing Address - Street 2:STE. 2
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-5583
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1956 THURGOOD MARSHALL HWY
Practice Address - Street 2:STE. 2
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-5583
Practice Address - Country:US
Practice Address - Phone:843-245-7202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health