Provider Demographics
NPI:1649858960
Name:SHORT GRASS INVESTMENT HOLDINGS LLC
Entity type:Organization
Organization Name:SHORT GRASS INVESTMENT HOLDINGS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-214-2059
Mailing Address - Street 1:3029 INDEPENDENCE DRIVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-4474
Mailing Address - Country:US
Mailing Address - Phone:830-214-2059
Mailing Address - Fax:830-214-8913
Practice Address - Street 1:3029 INDEPENDENCE DRIVE
Practice Address - Street 2:SUITE 105
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-4474
Practice Address - Country:US
Practice Address - Phone:830-214-2059
Practice Address - Fax:830-214-8913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care