Provider Demographics
NPI:1205289816
Name:CHRISTABEL, LLC
Entity type:Organization
Organization Name:CHRISTABEL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLALEYE
Authorized Official - Middle Name:AUGUSTINE
Authorized Official - Last Name:OLOWOOKERE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:312-451-6917
Mailing Address - Street 1:2704 WATERWAY DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-7251
Mailing Address - Country:US
Mailing Address - Phone:312-451-6917
Mailing Address - Fax:
Practice Address - Street 1:330 COOPER ST
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-2628
Practice Address - Country:US
Practice Address - Phone:312-451-6917
Practice Address - Fax:214-945-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX814598251J00000X
261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No251J00000XAgenciesNursing Care