=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457572109
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPHINX SUNRUNNERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2007
-----------------------------------------------------
Last Update Date | 08/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3319 35TH ST
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-792-9091
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2302 34TH ST
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79411-1634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-784-0033
-----------------------------------------------------
Fax | 806-784-0603
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. ANNETTE SCARBOROUGH
-----------------------------------------------------
Credential | RN, BSN
-----------------------------------------------------
Telephone | 806-784-0033
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 145563
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------