Basic Information
| Provider Information | |||||||||
| NPI: | 1508885658 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STONEGATE NURSING CENTER LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4201 STONEGATE BLVD | ||||||||
| Address2: | |||||||||
| City: | FT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761099503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179245440 | ||||||||
| FaxNumber: | 8179245447 | ||||||||
| Practice Location | |||||||||
| Address1: | 4201 STONEGATE BLVD | ||||||||
| Address2: | |||||||||
| City: | FT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761099503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8179245440 | ||||||||
| FaxNumber: | 8179245447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HAYES | ||||||||
| AuthorizedOfficialFirstName: | ALTA | ||||||||
| AuthorizedOfficialMiddleName: | SUE | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER-EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8179245440 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 5387 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.