Provider Demographics
NPI:1073501771
Name:BROWNWOOD OPERATIONS I. LTD.
Entity Type:Organization
Organization Name:BROWNWOOD OPERATIONS I. LTD.
Other - Org Name:SONGBIRD LODGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:817-303-4089
Mailing Address - Street 1:2500 SONG BIRD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-6488
Mailing Address - Country:US
Mailing Address - Phone:325-646-4750
Mailing Address - Fax:325-646-5697
Practice Address - Street 1:2500 SONG BIRD CIRCLE
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-6488
Practice Address - Country:US
Practice Address - Phone:325-646-4750
Practice Address - Fax:325-646-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109612314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001004530Medicaid
TX675959Medicare Oscar/Certification