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General NPI Number Information
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NPI Number | 1891781985
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Entity Type | Organization
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Legal Business Name | CATHEDRALROCK
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 300 E PRAIRIE ST
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City | WARSAW
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State | IN
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Zip | 46580-4429
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Country | US
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Telephone | 574-267-8922
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Fax | 574-268-2711
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Provider Business Mailing Address
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Address Line | 306 W 7TH ST 415 FORT WORTH CLUB BUILDING
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City | FORT WORTH
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State | TX
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Zip | 76102-4900
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Country | US
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Telephone | 817-335-4111
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Fax | 817-335-0800
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENT HARRINGTON
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Credential |
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Telephone | 817-335-4111
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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 | 050003591
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License Number State | IN
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