Healthcare Provider Details

I. General information

NPI: 1033891759
Provider Name (Legal Business Name): NEVILLE NGABE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10140 VIA COLOMBA CIR
FORT MYERS FL
33966-6549
US

IV. Provider business mailing address

407 E AYRE ST # 1162
WILMINGTON DE
19804-2512
US

V. Phone/Fax

Practice location:
  • Phone: 417-297-5142
  • Fax:
Mailing address:
  • Phone: 417-297-5142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: NEVILLE NGABE
Title or Position: CEO
Credential: RN
Phone: 417-297-5142