Provider Demographics
NPI:1912457144
Name:STONEBROOK COMMUNITY SERVICES, INC.
Entity type:Organization
Organization Name:STONEBROOK COMMUNITY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-223-8397
Mailing Address - Street 1:3132 VILLANDRY LN
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75033-1389
Mailing Address - Country:US
Mailing Address - Phone:469-223-8397
Mailing Address - Fax:972-704-3629
Practice Address - Street 1:3132 VILLANDRY LN
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-1389
Practice Address - Country:US
Practice Address - Phone:469-223-8397
Practice Address - Fax:972-704-3629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-12
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services