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General NPI Number Information
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NPI Number | 1740270651
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Entity Type | Organization
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Legal Business Name | BRENTWOOD HEALTHCARE, LTD
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Dates
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Enumeration Date | 10/24/2005
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 3505 S BUCKNER BLVD BLDG 3
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City | DALLAS
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State | TX
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Zip | 75227-5451
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Country | US
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Telephone | 214-388-0424
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Fax | 214-381-4454
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Provider Business Mailing Address
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Address Line | 600 E WHALEY ST
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City | LONGVIEW
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State | TX
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Zip | 75601-6525
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Country | US
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Telephone | 903-757-5360
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Fax | 903-236-7036
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Authorized Official
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Title or Position | PRES OF GENERAL PARTNER
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Name | DICK STEBBINS
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Credential | CPA
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Telephone | 903-757-5360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 110094
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License Number State | TX
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