Provider Demographics
NPI:1255674255
Name:NGEL
Entity Type:Organization
Organization Name:NGEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:AZUBIKE
Authorized Official - Last Name:TILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:QMHP
Authorized Official - Phone:972-986-2470
Mailing Address - Street 1:3939 US HIGHWAY 80 E
Mailing Address - Street 2:STE 305
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3359
Mailing Address - Country:US
Mailing Address - Phone:972-698-0404
Mailing Address - Fax:972-698-0844
Practice Address - Street 1:3939 US HIGHWAY 80 E
Practice Address - Street 2:STE 305
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3359
Practice Address - Country:US
Practice Address - Phone:972-698-0404
Practice Address - Fax:972-698-0844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities