Provider Demographics
NPI: | 1558784801 |
---|---|
Name: | GEORGETOWN SNF OPERATIONS LLC |
Entity Type: | Organization |
Organization Name: | GEORGETOWN SNF OPERATIONS LLC |
Other - Org Name: | ESTRELLA OAKS REHABILITATION AND CARE CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | AUTHORIZED OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PAULA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | PIERCE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 972-899-4401 |
Mailing Address - Street 1: | 1500 WATERS RIDGE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | LEWISVILLE |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 75057-6011 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 972-899-4401 |
Mailing Address - Fax: | 972-899-4806 |
Practice Address - Street 1: | 4011 WILLIAMS DR |
Practice Address - Street 2: | |
Practice Address - City: | GEORGETOWN |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78628-2491 |
Practice Address - Country: | US |
Practice Address - Phone: | 512-868-2700 |
Practice Address - Fax: | 512-868-2999 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-01-22 |
Last Update Date: | 2014-01-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |