Provider Demographics
NPI:1013061373
Name:RAMBLING OAKS COURTYARD ECC HIGHLAND VILLAGE LLC
Entity Type:Organization
Organization Name:RAMBLING OAKS COURTYARD ECC HIGHLAND VILLAGE LLC
Other - Org Name:RAMBLING OAKS COURTYARD EXTENSIVE CARE COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DIRK
Authorized Official - Middle Name:P
Authorized Official - Last Name:O'HARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-317-1174
Mailing Address - Street 1:112 BARNETT BLVD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-3176
Mailing Address - Country:US
Mailing Address - Phone:972-317-1174
Mailing Address - Fax:972-317-1175
Practice Address - Street 1:112 BARNETT BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-3176
Practice Address - Country:US
Practice Address - Phone:972-317-1174
Practice Address - Fax:972-317-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
676168Medicare Oscar/Certification