Provider Demographics
NPI:1447573670
Name:STONEGATE CENTER, LLC
Entity Type:Organization
Organization Name:STONEGATE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-448-8893
Mailing Address - Street 1:7510 FM 1886
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-1054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7510 FM 1886
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-1054
Practice Address - Country:US
Practice Address - Phone:817-448-8893
Practice Address - Fax:817-704-4576
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STONEGATE CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-02
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility