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NPI Code Detail

MEDICARE: STONEBRIDGE PLACE OF BRYAN LLC

MEDICARE: STONEBRIDGE PLACE OF BRYAN LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing FacilityTX

General Provider Information

NPI Number : 1285140798
Entity Type Code : Organization
Provider Name (Legal Business Name) : STONEBRIDGE PLACE OF BRYAN LLC
Provider Business Mailing Address
First Line : 1905 N 7TH ST
Second Line :
City : WEST MONROE
State : LA
Zip : 71291-4415
Country : US
Telephone Number : 318-812-2140
Fax Number :
Provider Business Practice Location Address
First Line : 2817 KENT ST
Second Line :
City : BRYAN
State : TX
Zip : 77802-5214
Country : US
Telephone Number : 979-776-7521
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : DAWNE SMITH
Credential :
Telephone Number : 318-812-2140
Provider Enumeration Date : 12/19/2017
Last Update Date : 12/19/2017

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Directions to “STONEBRIDGE PLACE OF BRYAN LLC ” Practice Location

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