Provider Demographics
NPI:1396917647
Name:FORTRESS HEALTH & REHAB OF ROCK PRAIRIE, LLC
Entity type:Organization
Organization Name:FORTRESS HEALTH & REHAB OF ROCK PRAIRIE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-937-7994
Mailing Address - Street 1:1105 ROCK PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8344
Mailing Address - Country:US
Mailing Address - Phone:979-694-2200
Mailing Address - Fax:979-696-6206
Practice Address - Street 1:1105 ROCK PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8344
Practice Address - Country:US
Practice Address - Phone:979-694-2200
Practice Address - Fax:979-696-6206
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DESCENDING DOVE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-27
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001016040Medicaid
455589Medicare Oscar/Certification