Healthcare Provider Details

I. General information

NPI: 1083088959
Provider Name (Legal Business Name): RIO ONE AT TARRANT COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2015
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3729 IRA E WOODS AVE
GRAPEVINE TX
76051-4213
US

IV. Provider business mailing address

8820 HORIZON BLVD NE
ALBUQUERQUE NM
87113-1689
US

V. Phone/Fax

Practice location:
  • Phone: 817-809-8000
  • Fax:
Mailing address:
  • Phone: 505-369-0079
  • Fax:

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: MRS. KELLEY WHITAKER
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 505-369-0079