STONEMERE REHABILITATION CENTER, LLC (STONEMERE REHABILITATION CENTER) - NPI NUMBER 1699111054

Summary

Provider Name: STONEMERE REHABILITATION CENTER, LLC (STONEMERE REHABILITATION CENTER)

NPI Number: 1699111054

Clasification: Skilled Nursing Facility (314000000X)

Address:
105 N TRENTON ST
RUSTON, LA
ZIP 71270

Phone Number: (318) 255-1514



Detailed Information

STONEMERE REHABILITATION CENTER, LLC is a skilled nursing facility in Ruston, LA. The provider is (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. The assigned NPI number for this provider is 1699111054 and is registered as an organization entity type.
The provider Is Doing Business As Stonemere Rehabilitation Center.

The provider's business address is:

105 N TRENTON ST
RUSTON, LA
ZIP 71270-321
Phone: (318) 255-1514
Fax: (318) 255-1517

The provider's authorized official is Danny K Prince .
The authorized official title is Member and has the following contact phone number (318) 255-1514.

The enumeration date for this NPI number is 5/13/2013 and was last updated on 6/2/2014.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 314000000X Skilled Nursing Facility 138649 TX Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 001025440 MEDICAID TX
2 676352 MEDICARE OSCAR/CERTIFICATION

NPI Record

No. Field Name Field Value
1 NPI 1699111054
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name STONEMERE REHABILITATION CENTER, LLC
5 Provider Other Organization Name STONEMERE REHABILITATION CENTER
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 105 N TRENTON ST
8 Provider Business Practice Location Address City Name RUSTON
9 Provider Business Practice Location Address State Name LA
10 Provider Business Practice Location Address Postal Code 712704321
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 3182551514
13 Provider Business Practice Location Address Fax Number 3182551517
14 Provider Enumeration Date 5/13/2013
15 Last Update Date 6/2/2014
16 Authorized Official Last Name PRINCE
17 Authorized Official First Name DANNY
18 Authorized Official Middle Name K
19 Authorized Official Title or Position MEMBER
20 Authorized Official Telephone Number 3182551514
21 Healthcare Provider Taxonomy Code 1 314000000X
22 Provider License Number 1 138649
23 Provider License Number State Code 1 TX
24 Healthcare Provider Primary Taxonomy Switch 1 Y
25 Other Provider Identifier 1 001025440
26 Other Provider Identifier Type Code 1 05
27 Other Provider Identifier State 1 TX
28 Other Provider Identifier 2 676352
29 Other Provider Identifier Type Code 2 06
30 Is Organization Subpart N
31 Authorized Official Name Prefix Text MR.

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This page was last updated on: 8/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.