Healthcare Provider Details

I. General information

NPI: 1104214352
Provider Name (Legal Business Name): STONERIDGE OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2014
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4017 FRANKLIN STREET
COLLEGE STATION AR
72053
US

IV. Provider business mailing address

4017 FRANKLIN STREET
COLLEGE STATION AR
72053
US

V. Phone/Fax

Practice location:
  • Phone: 501-490-1533
  • Fax:
Mailing address:
  • Phone: 501-490-1533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ROSS PONTHIE
Title or Position: MANAGING MEMBER
Credential:
Phone: 318-443-8167