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General NPI Number Information
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NPI Number | 1629207212
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Entity Type | Organization
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Legal Business Name | MRP II HEALTHCARE MANAGEMENT, LLC
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Dates
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Enumeration Date | 07/05/2009
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Last Update Date | 07/05/2009
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Provider Practice Location Address
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Address Line | 1300 SILVER CREEK AZLE RD
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City | AZLE
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State | TX
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Zip | 76020-3844
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Country | US
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Telephone | 817-238-8126
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Fax | 817-238-8784
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Provider Business Mailing Address
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Address Line | 4206 WATERFORD GLEN DR
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City | MANSFIELD
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State | TX
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Zip | 76063-9131
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Country | US
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Telephone | 817-475-2022
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Fax | 817-225-2660
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Authorized Official
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Title or Position | MANAGER
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Name | RICK PRUITT
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Credential |
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Telephone | 817-475-2022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | TX
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