Provider Demographics
NPI:1922418219
Name:NGU HOME, NEW LIFE
Entity Type:Organization
Organization Name:NGU HOME, NEW LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-584-9760
Mailing Address - Street 1:PO BOX 683168
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77268-3168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4166 SURREYDON DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77014-2152
Practice Address - Country:US
Practice Address - Phone:713-584-9760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities