Provider Demographics
NPI:1215374491
Name:STOCKDALE TX SNF MANAGEMENT LLC
Entity Type:Organization
Organization Name:STOCKDALE TX SNF MANAGEMENT LLC
Other - Org Name:STOCKDALE RESIDENCE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-747-8077
Mailing Address - Street 1:300 W SALMON ST
Mailing Address - Street 2:
Mailing Address - City:STOCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:78160-5907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 W SALMON ST
Practice Address - Street 2:
Practice Address - City:STOCKDALE
Practice Address - State:TX
Practice Address - Zip Code:78160-5907
Practice Address - Country:US
Practice Address - Phone:830-996-3721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility