Basic Information
| Provider Information | |||||||||
| NPI: | 1265790497 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SUGAR LAND GARDENS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4422 RIVERSTONE BLVD | ||||||||
| Address2: | |||||||||
| City: | MISSOURI CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774597150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016246487 | ||||||||
| FaxNumber: | 6017090832 | ||||||||
| Practice Location | |||||||||
| Address1: | 4422 RIVERSTONE BLVD | ||||||||
| Address2: | |||||||||
| City: | MISSOURI CITY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774597150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016246487 | ||||||||
| FaxNumber: | 6017090832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2012 | ||||||||
| LastUpdateDate: | 10/18/2012 | ||||||||
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| AuthorizedOfficialLastName: | STIGLER | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OPERATOR | ||||||||
| AuthorizedOfficialTelephone: | 2814995040 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.