=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154467231
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE INN OF SANGER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2007
-----------------------------------------------------
Last Update Date | 07/10/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 N STEMMONS ST
-----------------------------------------------------
City | SANGER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76266-9378
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-458-3202
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 930 RIDGEBROOK RD
-----------------------------------------------------
City | SPARKS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21152-9390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | STEVEN LOUDEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 940-458-3202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------