Provider Demographics
NPI:1891781985
Name:CATHEDRALROCK
Entity Type:Organization
Organization Name:CATHEDRALROCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-335-4111
Mailing Address - Street 1:306 W 7TH ST
Mailing Address - Street 2:415 FORT WORTH CLUB BUILDING
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-4900
Mailing Address - Country:US
Mailing Address - Phone:817-335-4111
Mailing Address - Fax:817-335-0800
Practice Address - Street 1:300 E PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-4429
Practice Address - Country:US
Practice Address - Phone:574-267-8922
Practice Address - Fax:574-268-2711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN050003591314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100274920Medicaid
ININ000359OtherFACILITY ID TRANSMISSION
INF46894Medicare UPIN
ING25534Medicare UPIN
ING83708Medicare UPIN
IN155566Medicare ID - Type UnspecifiedMEDICARE IDENTIFIER NUMBE
INE03752Medicare UPIN
INF66885Medicare UPIN
INE39364Medicare UPIN
ING17443Medicare UPIN
ING41461Medicare UPIN
INH06975Medicare UPIN
ING64403Medicare UPIN
INF02840Medicare UPIN
INF39916Medicare UPIN
ININ000359OtherFACILITY ID TRANSMISSION
INH84380Medicare UPIN
INE03751Medicare UPIN
INE35244Medicare UPIN
IN100274920Medicaid