Provider Demographics
NPI:1609189406
Name:RS GOLDEN TRIANGLE LLC
Entity Type:Organization
Organization Name:RS GOLDEN TRIANGLE LLC
Other - Org Name:OAK GROVE NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-304-1392
Mailing Address - Street 1:4885 E SHOALS CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5988
Mailing Address - Country:US
Mailing Address - Phone:337-304-1392
Mailing Address - Fax:
Practice Address - Street 1:6230 WARREN ST
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-4214
Practice Address - Country:US
Practice Address - Phone:409-963-1266
Practice Address - Fax:409-962-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX130712314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001018883Medicaid
TX005096OtherFACILITY ID
TX005096OtherFACILITY ID