Provider Demographics
NPI:1780076984
Name:SBLP KINGWOOD LLC
Entity type:Organization
Organization Name:SBLP KINGWOOD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-370-2626
Mailing Address - Street 1:5307 E MOCKINGBIRD LN
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75206-5109
Mailing Address - Country:US
Mailing Address - Phone:214-370-2626
Mailing Address - Fax:
Practice Address - Street 1:24025 KINGWOOD PLACE DR
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3862
Practice Address - Country:US
Practice Address - Phone:281-312-4400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX676330Medicare Oscar/Certification