# INDIVIDUAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356793509
- **Authorized official:** MS. PRISCA CHIOMA UGHANZE FNP (FAMILY NURSE PRACTITIONER)
- **Authorized official phone:** (817) 908-7822

## Contact information

- **Practice address:** 3500 TIMBERWOOD CIR APT 2137, ARLINGTON, TX 76015-3129
- **Practice address phone:** (817) 908-7822
- **Mailing address:** 3500 TIMBERWOOD CIR APT 2137, ARLINGTON, TX 76015-3129
- **Mailing address phone:** (817) 908-7822

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0401X | Comprehensive Outpatient Rehabilitation Facility (CORF) | — | NULL | Yes |

## Other

- **Enumeration date:** 07/11/2016
- **Last updated:** 07/11/2016