Provider Demographics
NPI:1528040839
Name:WINNIE-STOWELL HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:WINNIE-STOWELL HOSPITAL DISTRICT
Other - Org Name:PARK MANOR OF HUMBLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:DASPIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-419-5520
Mailing Address - Street 1:1780 HUGHES LANDING BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-4009
Mailing Address - Country:US
Mailing Address - Phone:281-419-5520
Mailing Address - Fax:281-419-5527
Practice Address - Street 1:19424 MCKAY BLVD
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5706
Practice Address - Country:US
Practice Address - Phone:281-319-4060
Practice Address - Fax:281-319-4565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112205314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001028690Medicaid
TX001012045Medicaid
TX5445Medicaid