Healthcare Provider Details

I. General information

NPI: 1609863109
Provider Name (Legal Business Name): CHEROKEE ROSE NURSING AND REHABILITATION LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 GIBBS BLVD
GLEN ROSE TX
76043-4309
US

IV. Provider business mailing address

401 N ELM ST
DENTON TX
76201-4137
US

V. Phone/Fax

Practice location:
  • Phone: 254-897-7361
  • Fax: 254-897-3627
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 Number109691
License Number StateTX

VIII. Authorized Official

Name: MR. MICHAEL A. RICH
Title or Position: PRESIDENT
Credential:
Phone: 940-387-4388