Provider Demographics
NPI:1316684947
Name:VOP STANELY HOUSE, LLC
Entity type:Organization
Organization Name:VOP STANELY HOUSE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAID BILLER/ASSISTANT PM
Authorized Official - Prefix:
Authorized Official - First Name:MARILYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-624-1044
Mailing Address - Street 1:1921 CORPORATE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-6075
Mailing Address - Country:US
Mailing Address - Phone:830-624-1044
Mailing Address - Fax:512-667-7770
Practice Address - Street 1:718 WALTON RD
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-9503
Practice Address - Country:US
Practice Address - Phone:850-951-1880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility