Healthcare Provider Details

I. General information

NPI: 1487185732
Provider Name (Legal Business Name): COTTONWOOD LONG TERM CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 10/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 COTTONWOOD CREEK TRAIL
CEDAR PARK TX
78613
US

IV. Provider business mailing address

1301 COTTONWOOD CREEK TRL
CEDAR PARK TX
78613-2091
US

V. Phone/Fax

Practice location:
  • Phone: 410-773-1000
  • Fax:
Mailing address:
  • Phone: 737-757-3100
  • Fax: 737-757-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RON BLASIG
Title or Position: PRESIDENT
Credential:
Phone: 737-757-3100