Provider Demographics
NPI:1407102601
Name:CALDWELL NURSING AND REHAB CENTER
Entity Type:Organization
Organization Name:CALDWELL NURSING AND REHAB CENTER
Other - Org Name:COPPERAS HOLLOW NURSING AND REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-601-1450
Mailing Address - Street 1:6340 S 3000 E
Mailing Address - Street 2:SUITE 330
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-3540
Mailing Address - Country:US
Mailing Address - Phone:801-601-1450
Mailing Address - Fax:801-996-3601
Practice Address - Street 1:345 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-2328
Practice Address - Country:US
Practice Address - Phone:979-567-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX134610314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility