Provider Demographics
NPI:1629207212
Name:MRP II HEALTHCARE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:MRP II HEALTHCARE MANAGEMENT, LLC
Other - Org Name:SILVER CREEK PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-475-2022
Mailing Address - Street 1:4206 WATERFORD GLEN DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-9131
Mailing Address - Country:US
Mailing Address - Phone:817-475-2022
Mailing Address - Fax:817-225-2660
Practice Address - Street 1:1300 SILVER CREEK AZLE RD
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3844
Practice Address - Country:US
Practice Address - Phone:817-238-8126
Practice Address - Fax:817-238-8784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-05
Last Update Date:2009-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000643OtherFACILITY ID