Organization
HP SUNNYBROOK OF TEXAS INC
Active
Other names
Sunnybrook Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS K MITTLEIDER (PRESIDENT)
(770) 619-0866
Entity
Organization
Contact information
Practice address
3050 SUNNYBROOK DRIVE, CORPUS CHRISTI, TX 78415-1797
(361) 853-9981
(361) 853-1907
Mailing address
925 N POINT PKWY, SUITE 440, ALPHARETTA, GA 30005-5210
(770) 619-0866
(770) 870-2892
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
113261
TX
332BN1400X
Nursing Facility Supplies (DME)
651
GA
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
651
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4245
—
TX
Enumeration date
07/09/2006
Last updated
11/12/2007
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