Provider Demographics
NPI:1790166502
Name:THE LODGE AT ROCKY HOLLOW
Entity Type:Organization
Organization Name:THE LODGE AT ROCKY HOLLOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:HOPE
Authorized Official - Last Name:PAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-793-2311
Mailing Address - Street 1:1650 COUNTY ROAD 245
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-4476
Mailing Address - Country:US
Mailing Address - Phone:254-793-2311
Mailing Address - Fax:254-793-2554
Practice Address - Street 1:1650 COUNTY ROAD 245
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-4476
Practice Address - Country:US
Practice Address - Phone:254-793-2311
Practice Address - Fax:254-793-2554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1024673104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances