Provider Demographics
NPI:1720149982
Name:NZEADIBE, GEOFFREY IHEUKWUMERE
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:IHEUKWUMERE
Last Name:NZEADIBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LUCKY
Other - Middle Name:
Other - Last Name:ENTERPRISE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4510 HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1869
Mailing Address - Country:US
Mailing Address - Phone:972-303-2800
Mailing Address - Fax:469-366-1655
Practice Address - Street 1:3960 BROADWAY BLVD STE 230
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-2591
Practice Address - Country:US
Practice Address - Phone:972-303-2800
Practice Address - Fax:469-442-0647
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No251B00000XAgenciesCase Management
No251X00000XAgenciesSupports BrokerageGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty