Provider Demographics
NPI:1467730259
Name:RISING STAR SNF LLC
Entity Type:Organization
Organization Name:RISING STAR SNF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUMPASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-399-6788
Mailing Address - Street 1:200 W HWY 6
Mailing Address - Street 2:SUITE 612
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3984
Mailing Address - Country:US
Mailing Address - Phone:254-399-6788
Mailing Address - Fax:254-399-6766
Practice Address - Street 1:411 S MILLER ST
Practice Address - Street 2:
Practice Address - City:RISING STAR
Practice Address - State:TX
Practice Address - Zip Code:76471-5214
Practice Address - Country:US
Practice Address - Phone:254-643-6700
Practice Address - Fax:254-643-1723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
675832Medicare Oscar/Certification