Provider Demographics
NPI:1508885658
Name:STONEGATE NURSING CENTER LTD
Entity Type:Organization
Organization Name:STONEGATE NURSING CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER-EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALTA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-924-5440
Mailing Address - Street 1:4201 STONEGATE BLVD
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-9503
Mailing Address - Country:US
Mailing Address - Phone:817-924-5440
Mailing Address - Fax:817-924-5447
Practice Address - Street 1:4201 STONEGATE BLVD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-9503
Practice Address - Country:US
Practice Address - Phone:817-924-5440
Practice Address - Fax:817-924-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5387314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
675759Medicare ID - Type Unspecified