Provider Demographics
NPI:1801179973
Name:STONEYBROOK HEALTHCARE & REHAB, LLC
Entity Type:Organization
Organization Name:STONEYBROOK HEALTHCARE & REHAB, LLC
Other - Org Name:STONEYBROOK HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-877-2024
Mailing Address - Street 1:4704 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4840
Mailing Address - Country:US
Mailing Address - Phone:423-877-2024
Mailing Address - Fax:423-877-2328
Practice Address - Street 1:3300 MILITARY RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-2581
Practice Address - Country:US
Practice Address - Phone:423-877-2024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-24
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
045399Medicare Oscar/Certification