Provider Demographics
NPI:1003851528
Name:RIVERCREST NURSING AND REHAB, INC.
Entity Type:Organization
Organization Name:RIVERCREST NURSING AND REHAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:EWING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-857-1099
Mailing Address - Street 1:PO BOX 828
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76095-0828
Mailing Address - Country:US
Mailing Address - Phone:817-857-1099
Mailing Address - Fax:817-857-1087
Practice Address - Street 1:120 WARDEN LN
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-6532
Practice Address - Country:US
Practice Address - Phone:512-353-8988
Practice Address - Fax:512-395-8974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111780314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-5803Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER