Healthcare Provider Details

I. General information

NPI: 1689951543
Provider Name (Legal Business Name): ROCK CREEK HEALTH AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 COLLEGE ST
SULPHUR SPRINGS TX
75482-3431
US

IV. Provider business mailing address

401 N ELM ST
DENTON TX
76201-4137
US

V. Phone/Fax

Practice location:
  • Phone: 903-439-0107
  • Fax: 903-439-0147
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 Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL G. WALLACE
Title or Position: PRESIDENT
Credential:
Phone: 940-387-4388