Healthcare Provider Details

I. General information

NPI: 1023474343
Provider Name (Legal Business Name): STONEGATE HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 JERRY SELBY DR
CROSSETT AR
71635-4734
US

IV. Provider business mailing address

118 JERRY SELBY DR
CROSSETT AR
71635-4734
US

V. Phone/Fax

Practice location:
  • Phone: 870-229-4282
  • Fax: 870-364-1533
Mailing address:
  • Phone: 870-229-4282
  • Fax: 870-364-1533

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: JOSEPH SCHWARTZ
Title or Position: MANAGER
Credential:
Phone: 201-635-1195