Provider Demographics
NPI:1306901061
Name:EJIOGU, NGOZI ROSE
Entity type:Individual
Prefix:
First Name:NGOZI
Middle Name:ROSE
Last Name:EJIOGU
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 1:1518 COYOTE HILLS LN
Mailing Address - Street 2:LANE
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-6236
Mailing Address - Country:US
Mailing Address - Phone:832-407-4047
Mailing Address - Fax:
Practice Address - Street 1:1518 COYOTE HILLS LN
Practice Address - Street 2:LANE
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-6236
Practice Address - Country:US
Practice Address - Phone:832-407-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX320900000XOtherCOMMUNITY BASED RESID.