Provider Demographics
NPI:1053471359
Name:THERESA O. NDUKWE
Entity Type:Organization
Organization Name:THERESA O. NDUKWE
Other - Org Name:STARBRIGHT HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:O
Authorized Official - Last Name:NDUKWE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:972-675-8188
Mailing Address - Street 1:710 SOTOGRANDE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-5117
Mailing Address - Country:US
Mailing Address - Phone:972-675-8188
Mailing Address - Fax:972-530-2485
Practice Address - Street 1:710 SOTOGRANDE DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-5117
Practice Address - Country:US
Practice Address - Phone:972-675-8188
Practice Address - Fax:972-530-2485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001007839Medicaid
TX001007840Medicaid
TX001007360Medicaid
TX001010165Medicaid