Provider Demographics
NPI:1457985400
Name:SAN AUGUSTINE MANAGEMENT LLC
Entity Type:Organization
Organization Name:SAN AUGUSTINE MANAGEMENT LLC
Other - Org Name:HILLCREST ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-556-5467
Mailing Address - Street 1:1997 DAVIDSON DR
Mailing Address - Street 2:
Mailing Address - City:SAN AUGUSTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75972-9788
Mailing Address - Country:US
Mailing Address - Phone:936-275-0222
Mailing Address - Fax:936-275-5978
Practice Address - Street 1:1997 DAVIDSON DR
Practice Address - Street 2:
Practice Address - City:SAN AUGUSTINE
Practice Address - State:TX
Practice Address - Zip Code:75972-9788
Practice Address - Country:US
Practice Address - Phone:936-275-0222
Practice Address - Fax:936-275-5978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility