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General NPI Number Information
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NPI Number | 1245690676
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Entity Type | Organization
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Legal Business Name | ASTRID VILLAGE ASSISTED CENTRE
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Dates
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Enumeration Date | 02/26/2016
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Last Update Date | 02/26/2016
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Provider Practice Location Address
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Address Line | 2860 CLEAR CREEK DR
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City | ROCKWALL
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State | TX
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Zip | 75032-9247
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Country | US
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Telephone | 214-766-1174
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Fax |
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Provider Business Mailing Address
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Address Line | 2548 PLAZA BLVD
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City | DALLAS
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State | TX
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Zip | 75241-6439
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Country | US
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Telephone | 214-766-1174
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | NGOZI STEPHANIE CHUKWUKELU
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Credential | RN
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Telephone | 214-766-1174
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 320700000X
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Taxonomy Name | Physical Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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