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General NPI Number Information
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NPI Number | 1790704989
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Entity Type | Organization
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Legal Business Name | STONECREST MEDICAL AND REHAB. CENTER, DBA CLASSIC HOMEHEALTH AGENCY
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 405 SUMMERTREE LN
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City | DESOTO
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State | TX
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Zip | 75115-5840
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Country | US
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Telephone | 972-274-1205
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Fax | 469-643-6404
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Provider Business Mailing Address
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Address Line | 405 SUMMERTREE LN
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City | DESOTO
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State | TX
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Zip | 75115-5840
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Country | US
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Telephone | 972-274-1205
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Fax | 469-643-6404
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Authorized Official
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Title or Position | ALT ADMINISTRATOR/CFO
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Name | JADE U IRONDI
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Credential |
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Telephone | 972-274-1205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number | 010430
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License Number State | TX
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