Healthcare Provider Details

I. General information

NPI: 1902368111
Provider Name (Legal Business Name): SUGARFRUIT PROPERTIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 12/30/2023
Certification Date: 12/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 STATE HIGHWAY 150 W
NEW WAVERLY TX
77358-5455
US

IV. Provider business mailing address

3701 STATE HIGHWAY 150 W
NEW WAVERLY TX
77358-5455
US

V. Phone/Fax

Practice location:
  • Phone: 346-901-9142
  • Fax:
Mailing address:
  • Phone: 346-901-9142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: LEARA ANNETTE BROWN
Title or Position: CEO
Credential:
Phone: 346-901-9142