Healthcare Provider Details

I. General information

NPI: 1376202234
Provider Name (Legal Business Name): DEER PARK NURSING AND REHAB CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W P ST
DEER PARK TX
77536-4802
US

IV. Provider business mailing address

206 W P ST
DEER PARK TX
77536-4802
US

V. Phone/Fax

Practice location:
  • Phone: 801-601-1450
  • Fax:
Mailing address:
  • Phone: 281-479-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DUSTIN MONROE
Title or Position: GENERAL COUNSEL
Credential:
Phone: 385-240-6408