Provider Demographics
NPI:1356755318
Name:STAMFORD TX MANAGEMENT LLC
Entity type:Organization
Organization Name:STAMFORD TX MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-596-5522
Mailing Address - Street 1:1003 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79553-6825
Mailing Address - Country:US
Mailing Address - Phone:325-773-3671
Mailing Address - Fax:325-773-5751
Practice Address - Street 1:1003 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:TX
Practice Address - Zip Code:79553-6825
Practice Address - Country:US
Practice Address - Phone:325-773-3671
Practice Address - Fax:325-773-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-18
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004930Medicaid
TX675769Medicare Oscar/Certification