Healthcare Provider Details

I. General information

NPI: 1912071580
Provider Name (Legal Business Name): STONEYBROOK HEALTHCARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 STONEY BROOK DR
HOUSTON TX
77063-4611
US

IV. Provider business mailing address

930 RIDGEBROOK RD
SPARKS MD
21152-9390
US

V. Phone/Fax

Practice location:
  • Phone: 713-782-4355
  • Fax:
Mailing address:
  • Phone:
  • 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: TAMMY MARTIN
Title or Position: PRESIDENT
Credential:
Phone: 713-782-4355