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NPI Code Detail

MEDICARE: STONEGATE SCC LLC

MEDICARE: STONEGATE SCC 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 Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2005387OTHERTXFACILITY/VENDOR ID

General Provider Information

NPI Number : 1902278732
Entity Type Code : Organization
Provider Name (Legal Business Name) : STONEGATE SCC LLC
Provider Business Mailing Address
First Line : 14841 DALLAS PKWY
Second Line :
City : DALLAS
State : TX
Zip : 75254-7685
Country : US
Telephone Number : 214-252-7600
Fax Number :
Provider Business Practice Location Address
First Line : 4201 STONEGATE BLVD
Second Line :
City : FT WORTH
State : TX
Zip : 76109-9503
Country : US
Telephone Number : 817-924-5440
Fax Number :
Authorized Official
Title or Position : CHIEF OPERATIONS OFFICER
Name : MICHAEL TEMPLETON
Credential :
Telephone Number : 214-252-7600
Provider Enumeration Date : 10/20/2015
Last Update Date : 03/16/2022

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