# SOLE PROPRIETER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881998391
- **Authorized official:** STEPHANIE RAE REDDING (COTA)
- **Authorized official phone:** (210) 748-2945

## Contact information

- **Practice address:** 526 PORTRUSH LN, CIBOLO, TX 78108-4340
- **Practice address phone:** (210) 748-2945
- **Mailing address:** 526 PORTRUSH LN, CIBOLO, TX 78108

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 3040 | AL | — |
| 314000000X | Skilled Nursing Facility | 10990 | FL | Yes |

## Other

- **Enumeration date:** 12/28/2010
- **Last updated:** 12/28/2010