MEDICARE: MERIDIAN ROCKPORT ALF, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	113898	TX
2	314000000X	Skilled Nursing Facility	129349	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245224054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERIDIAN ROCKPORT ALF, LP

Provider Business Mailing Address
First Line	:	2828 N. HARWOOD
Second Line	:	SUITE 1100
City	:	DALLAS
State	:	TX
Zip	:	75201-1512
Country	:	US
Telephone Number	:	214-252-7600
Fax Number	:	214-252-7704

Provider Business Practice Location Address
First Line	:	900 ENTERPRISE BLVD
Second Line	:
City	:	ROCKPORT
State	:	TX
Zip	:	78382
Country	:	US
Telephone Number	:	361-729-5254
Fax Number	:	361-729-3820

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID RONCK
Credential	:
Telephone Number	:	214-651-4000

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	05/30/2012

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