MEDICARE: STONEBRIDGE STRUCTURED INDEPENDENT LIVING, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker
3	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1205016128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONEBRIDGE STRUCTURED INDEPENDENT LIVING, INC

Provider Business Mailing Address
First Line	:	PO BOX 692368
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77269-2368
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5303 PEBBLE SPRINGS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77066-2542
Country	:	US
Telephone Number	:	832-326-5000
Fax Number	:	888-315-2272

Authorized Official
Title or Position	:	DIRECTOR
Name	:	REBECCAH WALKER
Credential	:
Telephone Number	:	832-326-5000

Provider Enumeration Date	:	11/08/2007
Last Update Date	:	02/14/2017

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