Healthcare Provider Details

I. General information

NPI: 1790704989
Provider Name (Legal Business Name): STONECREST MEDICAL AND REHAB. CENTER, DBA CLASSIC HOMEHEALTH AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 SUMMERTREE LN
DESOTO TX
75115-5840
US

IV. Provider business mailing address

405 SUMMERTREE LN
DESOTO TX
75115-5840
US

V. Phone/Fax

Practice location:
  • Phone: 972-274-1205
  • Fax: 469-643-6404
Mailing address:
  • Phone: 972-274-1205
  • Fax: 469-643-6404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number010430
License Number StateTX

VIII. Authorized Official

Name: JADE U IRONDI
Title or Position: ALT ADMINISTRATOR/CFO
Credential:
Phone: 972-274-1205