STONEWALL RESIDENTIAL CARE, LLC (NPI# 1700200011) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700200011 |
| Entity Type | Organization |
| Organization Name | STONEWALL RESIDENTIAL CARE, LLC |
| Practice Address |
28921 N. River Estates Chattaroy WA 99003 |
| Practice Telephone | 5094139129 |
| Practice Fax Number | 5092095684 |
| Mailing Telephone | 5094139129 |
| Mailing Fax Number | 5092095684 |
| Enumeration Date | 2014-02-06 |
| Last Update Date | 2014-02-06 |
| Authorized Official Name | ANGELA CAROL BELLAR (OWNER/PROVIDER) |
| Authorized Official Telephone | 5094139129 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320600000X | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 751213 | WA | Residential Treatment Facilities |
| Street Address |
28921 N. RIVER ESTATES |
| City | CHATTAROY |
| State | WA |
| Zip Code | 99003 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578061180 | Amy Anne Surnock | Nurse Practitioner | 1450 San Pablo Street, Suite 5000, Los Angeles, CA 99003 | 2018-01-29 |
| 1902859895 | Jessica A. Blackwell | Nurse Practitioner | 3419 E Elena Ln, Chattaroy, WA 99003-5121 | 2006-05-19 |
| 1669087367 | Village Health Telehealth Pllc | Clinic/Center | 3419 E Elena Ln, Chattaroy, WA 99003-5121 | 2020-09-10 |
| 1164772018 | Kristi Alana Conley | Community Health Worker | 13011 E Deer Creek Rd, Chattaroy, WA 99003-7001 | 2012-09-18 |
| 1316922792 | Victor S Stime | Dentist | 34705 N Newport Hwy, Riverside Dental Clinic, Chattaroy, WA 99003-7711 | 2005-12-08 |
| 1225087539 | David A Bennett | Pediatrics | 34705 N Newport Hwy, Chattaroy, WA 99003-7711 | 2006-05-06 |
| 1598713463 | David A Bennett Md | Pediatrics | 34705 N Newport Hwy, Chattaroy, WA 99003-7711 | 2006-05-04 |
| 1912976838 | Nathan P Stime | Family Medicine | 34705 N Newport Hwy, Suite A, Chattaroy, WA 99003-7711 | 2006-03-14 |
| 1376512293 | Nathan P Stime Md Riverside Medical-dental Clinic | Family Medicine | 34705 N Newport Hwy, Suite A, Chattaroy, WA 99003-7711 | 2006-03-14 |
| 1821472424 | Suzanna Toews | Social Worker | 35516 N Dunn Rd, Chattaroy, WA 99003-7726 | 2015-07-13 |
| Find all providers in zip 99003 | ||||
| Taxonomy Code | 320600000X |
| Grouping | Residential Treatment Facilities |
| Classification | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366820029 | Marina Tikhonova | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2419 E 8th Ave, Spokane, WA 99202-4213 | 2015-05-14 |
| 1992149777 | Holly Renee Cordero | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 13224 E Tall Tree Rd, Spokane Valley, WA 99216-2411 | 2013-04-23 |
| 1538409826 | Life Works | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 906 New York St, Longview, WA 98632-4132 | 2013-02-22 |
| 1063717189 | Healthcare Harmony LLC | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 11406 E Fairview Ave, Spokane Valley, WA 99206-4687 | 2011-01-20 |
| 1790038420 | Jody Lyn Genuard | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 9330 59th Ave Sw, Lakewood, WA 98499-2858 | 2012-10-18 |
| 1568625622 | Lyneeka Janee Collins | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 811 Madison St, Everett, WA 98203-4543 | 2008-07-08 |
| 1164547626 | Rainier State School | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 2120 Ryan Rd, Buckley, WA 98321-9115 | 2007-03-20 |
Please comment or provide details below to improve the information on STONEWALL RESIDENTIAL CARE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.