1639574825 NPI number — SUGARLAND SNF, LLC

Table of content: (NPI 1639574825)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639574825 NPI number — SUGARLAND SNF, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUGARLAND SNF, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE SYCAMORES AT SUGAR LAND
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639574825
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1910 FAIRVIEW AVE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98102-3620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-453-0290
Provider Business Mailing Address Fax Number:
206-694-2705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
770 BROOK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-565-6722
Provider Business Practice Location Address Fax Number:
206-694-2705
Provider Enumeration Date:
10/30/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WASHBURN
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
206-453-0290

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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