Healthcare Provider Details

I. General information

NPI: 1336570274
Provider Name (Legal Business Name): CHP ISLE AT CEDAR RIDGE TX TENANT CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S LAKELINE BLVD
CEDAR PARK TX
78613-4567
US

IV. Provider business mailing address

2200 S LAKELINE BLVD
CEDAR PARK TX
78613-4567
US

V. Phone/Fax

Practice location:
  • Phone: 512-219-0200
  • Fax:
Mailing address:
  • Phone: 512-219-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HOLLY J GREER
Title or Position: SECRETARY
Credential:
Phone: 470-540-7500