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General NPI Number Information
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NPI Number | 1376202234
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Entity Type | Organization
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Legal Business Name | DEER PARK NURSING AND REHAB CENTER LLC
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 05/12/2022
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Provider Practice Location Address
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Address Line | 206 W P ST
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City | DEER PARK
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State | TX
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Zip | 77536-4802
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Country | US
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Telephone | 801-601-1450
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Fax |
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Provider Business Mailing Address
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Address Line | 206 W P ST
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City | DEER PARK
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State | TX
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Zip | 77536-4802
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Country | US
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Telephone | 281-479-8471
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Fax |
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Authorized Official
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Title or Position | GENERAL COUNSEL
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Name | DUSTIN MONROE
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Credential |
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Telephone | 385-240-6408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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