Healthcare Provider Details

I. General information

NPI: 1366726762
Provider Name (Legal Business Name): MASON ROUND ROCK OP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 COLLEGE PARK DRIVE
ROUND ROCK TX
78665-1522
US

IV. Provider business mailing address

4100 COLLEGE PARK DRIVE
ROUND ROCK TX
78665-1522
US

V. Phone/Fax

Practice location:
  • Phone: 512-334-8000
  • Fax: 512-334-8005
Mailing address:
  • Phone: 512-334-8000
  • Fax: 512-334-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number133434
License Number StateTX

VIII. Authorized Official

Name: MICHAEL A. LITTLE
Title or Position: ADMINISTRATOR
Credential:
Phone: 512-334-8000