1740495837 NPI number — SUTTON HEALTH CARE CENTER LTD CO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740495837 NPI number — SUTTON HEALTH CARE CENTER LTD CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUTTON HEALTH CARE CENTER LTD CO
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:
Provider Other Organization Name Type Code:
6
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:
1740495837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/20/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2537 GOLDEN BEAR DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75006-2377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-954-4114
Provider Business Mailing Address Fax Number:
214-871-3057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1350 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-4348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-705-9108
Provider Business Practice Location Address Fax Number:
214-705-9939
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
UNDERHILL
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
214-954-4114

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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