Provider Demographics
NPI:1104214352
Name:STONERIDGE OPERATIONS, LLC
Entity Type:Organization
Organization Name:STONERIDGE OPERATIONS, LLC
Other - Org Name:STONERIDGE NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:PONTHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-443-8167
Mailing Address - Street 1:4017 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:AR
Mailing Address - Zip Code:72053
Mailing Address - Country:US
Mailing Address - Phone:501-490-1533
Mailing Address - Fax:
Practice Address - Street 1:4017 FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:AR
Practice Address - Zip Code:72053
Practice Address - Country:US
Practice Address - Phone:501-490-1533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR045425Medicare Oscar/Certification