Provider Demographics
NPI:1952748956
Name:RUSK NURSING & REHAB CENTER LLC
Entity Type:Organization
Organization Name:RUSK NURSING & REHAB CENTER LLC
Other - Org Name:CHEROKEE TRAILS NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BLALOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-744-5249
Mailing Address - Street 1:403 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:75840-1603
Mailing Address - Country:US
Mailing Address - Phone:903-389-1009
Mailing Address - Fax:903-389-1090
Practice Address - Street 1:330 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:RUSK
Practice Address - State:TX
Practice Address - Zip Code:75785-1930
Practice Address - Country:US
Practice Address - Phone:903-683-5438
Practice Address - Fax:903-683-8418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-30
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675835Medicare Oscar/Certification