Provider Demographics
NPI:1164808911
Name:GRUENEPOINTE 1 BROWNWOOD, LLC
Entity Type:Organization
Organization Name:GRUENEPOINTE 1 BROWNWOOD, LLC
Other - Org Name:SONGBIRD LODGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:DULLNIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-757-4987
Mailing Address - Street 1:8502 HUEBNER RD STE 400
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2466
Mailing Address - Country:US
Mailing Address - Phone:210-757-4987
Mailing Address - Fax:
Practice Address - Street 1:2500 SONG BIRD CIR
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAPLIED FOR314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001027117Medicaid
TX145384OtherSTATE LICENSE
TX145384OtherSTATE LICENSE