Provider Demographics
NPI:1487185732
Name:COTTONWOOD LONG TERM CARE LLC
Entity Type:Organization
Organization Name:COTTONWOOD LONG TERM CARE LLC
Other - Org Name:CEDAR POINTE HEALTH AND WELLNESS SUITES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLASIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:737-757-3100
Mailing Address - Street 1:1301 COTTONWOOD CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2091
Mailing Address - Country:US
Mailing Address - Phone:737-757-3100
Mailing Address - Fax:737-757-3101
Practice Address - Street 1:1301 COTTONWOOD CREEK TRAIL
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:410-773-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility