1952748956 NPI number — RUSK NURSING & REHAB CENTER LLC

Table of content: (NPI 1952748956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952748956 NPI number — RUSK NURSING & REHAB CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RUSK NURSING & REHAB CENTER LLC
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:
CHEROKEE TRAILS NURSING HOME
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:
1952748956
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
403 E COMMERCE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75840-1603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-389-1009
Provider Business Mailing Address Fax Number:
903-389-1090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
330 BAGLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75785-1930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-683-5438
Provider Business Practice Location Address Fax Number:
903-683-8418
Provider Enumeration Date:
05/30/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BLALOCK
Authorized Official First Name:
BEVERLY
Authorized Official Middle Name:
K
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
254-744-5249

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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