Nela LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

License

AL1077 Issued in FL

Legal business name

NELA LLC

Doing business as

DIXIE LODGE

Practice address

647 S Woodland Blvd
Deland, FL 32720-5810

Phone

(386) 734-4830

NPI assigned

Jan 28, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacek Dygdon

Title

Owner

Phone

(386) 734-4830

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• DIXIE LODGE Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1390867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390867200000",
    "number": "1114340155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "647 S WOODLAND BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327205810",
            "telephone_number": "386-734-4830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "647 S WOODLAND BLVD",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327205810",
            "telephone_number": "386-734-4830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NELA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-28",
        "last_updated": "2014-01-28",
        "status": "A",
        "authorized_official_last_name": "DYGDON",
        "authorized_official_first_name": "JACEK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-734-4830"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "FL",
            "license": "AL1077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002508600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DIXIE LODGE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carol S Nagengast, M.S. CCC SLP
• Marjan Naghavi, LMHC
• Urvashi Nath
• Kourosh Nazari, M.D.
• Charles E Neetz, FNP
• Brittany Lynne Nelson, PT, DPT
• Treena Nelson
• Rhiannon Neuharth, CFNC
• Linda Newsome, LMHC
• Robert Newsome, MA

• Mental Illness Community Based Residential Treatment Facility in Deland, FL
• Providers in Deland, FL by specialty
• Mental Illness Community Based Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.