Healthcare Provider Details

I. General information

NPI: 1740613009
Provider Name (Legal Business Name): EAGLE LAKE NURSING AND REHABILITATION, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 02/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 S AUSTIN ROAD
EAGLE LAKE TX
77434
US

IV. Provider business mailing address

419 S ELM ST
DENTON TX
76201-6085
US

V. Phone/Fax

Practice location:
  • Phone: 979-243-3910
  • Fax: 979-234-2926
Mailing address:
  • Phone: 940-387-4388
  • Fax: 940-380-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number139519
License Number StateTX

VIII. Authorized Official

Name: MR. DAN D FLAGG
Title or Position: CEO
Credential:
Phone: 940-387-4388