Sagebrush Living Center LTD

Primary specialty

Mental Illness Intermediate Care FacilityTaxonomy code 310500000X

License

003705 Issued in TX

Legal business name

SAGEBRUSH LIVING CENTER LTD

Practice address

1101 Columbia
Stamford, TX 79553

Phone

(325) 773-2791

NPI assigned

Apr 24, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mike Hawker

Title

Cfo

Phone

(210) 340-7155

Specialties & licenses 1

Addresses

Other names 1

• Sagebrush Living Center Other name

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174589683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 PROTON RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584203",
            "telephone_number": "210-340-7155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 COLUMBIA",
            "city": "STAMFORD",
            "state": "TX",
            "postal_code": "79553",
            "telephone_number": "325-773-2791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGEBRUSH LIVING CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HAWKER",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "210-340-7155",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310500000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Mental Illness",
            "state": "TX",
            "license": "003705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sagebrush Living Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Celina Alysse Serfontein, M.S., CCC-SLP
• Shaughn T. SMS D.C., P. C.
• Stamford EMS, Inc
• Stamford Healthcare Management LLC
• Stamford Hospital District

• Mental Illness Intermediate Care Facility in Stamford, TX
• Providers in Stamford, TX by specialty
• Mental Illness Intermediate Care Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.