Provider Demographics
NPI:1558685727
Name:NGALLA, BINTA MAMBOH
Entity Type:Individual
Prefix:MS
First Name:BINTA
Middle Name:MAMBOH
Last Name:NGALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1974 BISHOP HL
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8765
Mailing Address - Country:US
Mailing Address - Phone:248-798-7022
Mailing Address - Fax:214-705-0068
Practice Address - Street 1:1974 BISHOP HL
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8765
Practice Address - Country:US
Practice Address - Phone:248-798-7022
Practice Address - Fax:214-705-0068
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child