Provider Demographics
NPI:1639117005
Name:STONEBRIDGE HEALTH CENTER, INC
Entity Type:Organization
Organization Name:STONEBRIDGE HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:HORABIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-703-2200
Mailing Address - Street 1:11127 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78736-7767
Mailing Address - Country:US
Mailing Address - Phone:512-288-8844
Mailing Address - Fax:512-288-5333
Practice Address - Street 1:11127 CIRCLE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78736-7767
Practice Address - Country:US
Practice Address - Phone:512-288-8844
Practice Address - Fax:512-288-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004215314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000421506Medicaid
TX0227803-02Medicaid
TX0227803-01Medicaid
TX0227803-01Medicaid