1356434278 NPI number — RANCIER NURSING CENTER INC

Table of content: (NPI 1356434278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356434278 NPI number — RANCIER NURSING CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANCIER NURSING CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE ROSEWOOD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356434278
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5700 E CENTRAL TEXAS EXPRESSWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILLEEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-690-6169
Provider Business Mailing Address Fax Number:
254-699-2962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5700 E CENTRAL TEXAS EXPRESSWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KILLEEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-690-6169
Provider Business Practice Location Address Fax Number:
254-699-2962
Provider Enumeration Date:
10/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCULLARK
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MEDICARE COORDINATOR
Authorized Official Telephone Number:
863-646-5951

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  116826 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000428806 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 094417503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004288 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116826 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 094417501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".