Provider Demographics
NPI:1326397126
Name:KNOTTS LANDING
Entity Type:Organization
Organization Name:KNOTTS LANDING
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RONALDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:STELLY
Authorized Official - Suffix:
Authorized Official - Credentials:LVN
Authorized Official - Phone:281-458-7277
Mailing Address - Street 1:6606 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77028-4165
Mailing Address - Country:US
Mailing Address - Phone:281-458-7277
Mailing Address - Fax:
Practice Address - Street 1:6606 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028-4165
Practice Address - Country:US
Practice Address - Phone:281-458-7277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1174704811Medicaid