Healthcare Provider Details

I. General information

NPI: 1891781985
Provider Name (Legal Business Name): CATHEDRALROCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E PRAIRIE ST
WARSAW IN
46580-4429
US

IV. Provider business mailing address

306 W 7TH ST 415 FORT WORTH CLUB BUILDING
FORT WORTH TX
76102-4900
US

V. Phone/Fax

Practice location:
  • Phone: 574-267-8922
  • Fax: 574-268-2711
Mailing address:
  • Phone: 817-335-4111
  • Fax: 817-335-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number050003591
License Number StateIN

VIII. Authorized Official

Name: KENT HARRINGTON
Title or Position: PRESIDENT
Credential:
Phone: 817-335-4111