Provider Demographics
NPI:1790704989
Name:STONECREST MEDICAL AND REHAB. CENTER, DBA CLASSIC HOMEHEALTH AGENCY
Entity Type:Organization
Organization Name:STONECREST MEDICAL AND REHAB. CENTER, DBA CLASSIC HOMEHEALTH AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALT ADMINISTRATOR/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JADE
Authorized Official - Middle Name:U
Authorized Official - Last Name:IRONDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-274-1205
Mailing Address - Street 1:405 SUMMERTREE LN
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5840
Mailing Address - Country:US
Mailing Address - Phone:972-274-1205
Mailing Address - Fax:469-643-6404
Practice Address - Street 1:405 SUMMERTREE LN
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5840
Practice Address - Country:US
Practice Address - Phone:972-274-1205
Practice Address - Fax:469-643-6404
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
TX010430372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty