MEDICARE: SPRING CREEK NURSING AND REHABILITATION LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1553372 02	OTHER	TX	TMHP CROSS OVER

General Provider Information

NPI Number	:	1164418935
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRING CREEK NURSING AND REHABILITATION LP

Provider Business Mailing Address
First Line	:	419 S ELM ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-6085
Country	:	US
Telephone Number	:	940-387-4388
Fax Number	:	940-380-2410

Provider Business Practice Location Address
First Line	:	2660 BRICKYARD RD
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77703-4708
Country	:	US
Telephone Number	:	409-892-1533
Fax Number	:	409-892-1405

Authorized Official
Title or Position	:	CEO
Name	:	MR. DAN D FLAGG
Credential	:
Telephone Number	:	940-387-4388

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	02/12/2019

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