MEDICARE: STONEBRIDGE HEALTH CENTER, INC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	004215	TX

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1639117005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STONEBRIDGE HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	11127 CIRCLE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-7767
Country	:	US
Telephone Number	:	512-288-8844
Fax Number	:	512-288-5333

Provider Business Practice Location Address
First Line	:	11127 CIRCLE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78736-7767
Country	:	US
Telephone Number	:	512-288-8844
Fax Number	:	512-288-5333

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. WILLIAM C HORABIN
Credential	:
Telephone Number	:	512-703-2200

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	06/12/2009

11127 CIRCLE DRIVE
AUSTIN, TX
78736-7767

Practice Phone: 512-288-8844
Practice Fax: 512-288-5333