Healthcare Provider Details

I. General information

NPI: 1205016128
Provider Name (Legal Business Name): STONEBRIDGE STRUCTURED INDEPENDENT LIVING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5303 PEBBLE SPRINGS DR
HOUSTON TX
77066-2542
US

IV. Provider business mailing address

PO BOX 692368
HOUSTON TX
77269-2368
US

V. Phone/Fax

Practice location:
  • Phone: 832-326-5000
  • Fax: 888-315-2272
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: REBECCAH WALKER
Title or Position: DIRECTOR
Credential:
Phone: 832-326-5000