Healthcare Provider Details

I. General information

NPI: 1801056379
Provider Name (Legal Business Name): SOLID ROCK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1300 DUNDEE DR
ARLINGTON TX
76002-3746
US

IV. Provider business mailing address

1300 DUNDEE DR
ARLINGTON TX
76002-3746
US

V. Phone/Fax

Practice location:
  • Phone: 817-789-4966
  • Fax:
Mailing address:
  • Phone: 817-789-4966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. OLATUNJI OLALEYE USMAN
Title or Position: MANAGER
Credential:
Phone: 817-344-9159