Provider Demographics
NPI:1427033968
Name:SULIK SHERIDAN ROCK PRIARIE INC.
Entity Type:Organization
Organization Name:SULIK SHERIDAN ROCK PRIARIE INC.
Other - Org Name:SHERIDAN ON ROCK PRAIRIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-846-4633
Mailing Address - Street 1:PO BOX 4045
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77805-4045
Mailing Address - Country:US
Mailing Address - Phone:979-846-4633
Mailing Address - Fax:979-846-7674
Practice Address - Street 1:1105 ROCK PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8344
Practice Address - Country:US
Practice Address - Phone:979-694-2200
Practice Address - Fax:979-696-6206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110716314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
4952OtherVENDOR NUMBER
4952OtherVENDOR NUMBER