Provider Demographics
NPI:1245690676
Name:ASTRID VILLAGE ASSISTED CENTRE
Entity type:Organization
Organization Name:ASTRID VILLAGE ASSISTED CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:STEPHANIE
Authorized Official - Last Name:CHUKWUKELU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-766-1174
Mailing Address - Street 1:2548 PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75241-6439
Mailing Address - Country:US
Mailing Address - Phone:214-766-1174
Mailing Address - Fax:
Practice Address - Street 1:2860 CLEAR CREEK DR
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-9247
Practice Address - Country:US
Practice Address - Phone:214-766-1174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320600000X, 320700000X, 320800000X, 320900000X
TX320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness