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General NPI Number Information
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NPI Number | 1003867201
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Entity Type | Organization
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Legal Business Name | GRCC HOLDINGS LTD
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 930 ROY RICHARD DR
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City | SCHERTZ
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State | TX
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Zip | 78154-1050
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Country | US
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Telephone | 210-566-9100
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Fax | 210-566-9102
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Provider Business Mailing Address
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Address Line | 930 ROY RICHARD DR
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City | SCHERTZ
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State | TX
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Zip | 78154-1050
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Country | US
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Telephone | 210-566-9100
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Fax | 210-566-9102
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Authorized Official
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Title or Position | LIMITED PARTNER
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Name | MR. JAKE HALLSTED
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Credential |
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Telephone | 210-566-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 102647
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License Number State | TX
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