Provider Demographics
NPI:1598270878
Name:STANWICK SENIOR CARE LLC
Entity Type:Organization
Organization Name:STANWICK SENIOR CARE LLC
Other - Org Name:COURTYARD NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-741-5929
Mailing Address - Street 1:PO BOX 23648
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76702-3648
Mailing Address - Country:US
Mailing Address - Phone:254-741-5929
Mailing Address - Fax:254-741-5928
Practice Address - Street 1:7499 STANWICK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-6119
Practice Address - Country:US
Practice Address - Phone:254-741-5929
Practice Address - Fax:254-741-5928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-07
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility