Provider Demographics
NPI:1588667604
Name:TERRICK PROPERTIES INC
Entity Type:Organization
Organization Name:TERRICK PROPERTIES INC
Other - Org Name:SOUTHERN SPECIALTY REHAB AND NURSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-780-7000
Mailing Address - Street 1:4320 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2407
Mailing Address - Country:US
Mailing Address - Phone:806-795-1774
Mailing Address - Fax:806-795-4652
Practice Address - Street 1:4320 W 19TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2407
Practice Address - Country:US
Practice Address - Phone:806-795-1774
Practice Address - Fax:806-795-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113881314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171058401Medicaid
TX001012545Medicaid
TX4235Medicaid
TX676028Medicare ID - Type UnspecifiedPROVIDER NUMBER