Provider Demographics
NPI:1609246529
Name:RHINESTONE RESOURCE GROUP LLC
Entity Type:Organization
Organization Name:RHINESTONE RESOURCE GROUP LLC
Other - Org Name:RHINESTONE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:COBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-592-3021
Mailing Address - Street 1:4204 STONEBRIAR TRL
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5875
Mailing Address - Country:US
Mailing Address - Phone:817-592-3021
Mailing Address - Fax:888-557-1669
Practice Address - Street 1:2363 HIGHWAY 287 N STE 205
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-7587
Practice Address - Country:US
Practice Address - Phone:817-592-3021
Practice Address - Fax:888-557-1669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4121493-01Medicaid