Provider Demographics
NPI:1588815203
Name:HEALTHCARE AND REHAB OF KINGSTON, LLC
Entity Type:Organization
Organization Name:HEALTHCARE AND REHAB OF KINGSTON, LLC
Other - Org Name:HEALTHCARE AND REHAB OF KINGSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-992-2028
Mailing Address - Street 1:7429 AIRPORT FWY
Mailing Address - Street 2:
Mailing Address - City:RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76118-6955
Mailing Address - Country:US
Mailing Address - Phone:817-595-4411
Mailing Address - Fax:
Practice Address - Street 1:HC 71 BOX 83
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439-9701
Practice Address - Country:US
Practice Address - Phone:580-564-2216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX375437Medicare Oscar/Certification