Healthcare Provider Details

I. General information

NPI: 1407102601
Provider Name (Legal Business Name): CALDWELL NURSING AND REHAB CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 07/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 COUNTRY CLUB DR
CALDWELL TX
77836-2328
US

IV. Provider business mailing address

6340 S 3000 E SUITE 330
SALT LAKE CITY UT
84121-3540
US

V. Phone/Fax

Practice location:
  • Phone: 979-567-6400
  • Fax:
Mailing address:
  • Phone: 801-601-1450
  • Fax: 801-996-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number134610
License Number StateTX

VIII. Authorized Official

Name: BRIAN RAMOS
Title or Position: MANAGING MEMBER
Credential:
Phone: 801-601-1450