Provider Demographics
NPI:1902408156
Name:FLINTROCK FALLS HEALTHCARE, INC.
Entity Type:Organization
Organization Name:FLINTROCK FALLS HEALTHCARE, INC.
Other - Org Name:LAKEWAY SKILLED NURSING AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:1917 LOHMANS CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5269
Mailing Address - Country:US
Mailing Address - Phone:512-261-3211
Mailing Address - Fax:512-261-7147
Practice Address - Street 1:1917 LOHMANS CROSSING RD
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5269
Practice Address - Country:US
Practice Address - Phone:512-261-3211
Practice Address - Fax:512-261-7147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility