MEDICARE: SULIK SHERIDAN ROCK PRIARIE INC.

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	314000000X	Skilled Nursing Facility	110716	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4952	OTHER		VENDOR NUMBER

General Provider Information

NPI Number	:	1427033968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SULIK SHERIDAN ROCK PRIARIE INC.

Provider Business Mailing Address
First Line	:	PO BOX 4045
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77805-4045
Country	:	US
Telephone Number	:	979-846-4633
Fax Number	:	979-846-7674

Provider Business Practice Location Address
First Line	:	1105 ROCK PRAIRIE RD
Second Line	:
City	:	COLLEGE STATION
State	:	TX
Zip	:	77845-8344
Country	:	US
Telephone Number	:	979-694-2200
Fax Number	:	979-696-6206

Authorized Official
Title or Position	:	CAO
Name	:	MS. LYNDA BEARD
Credential	:
Telephone Number	:	979-846-4633

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	08/22/2020

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Directions to “SULIK SHERIDAN ROCK PRIARIE INC. ” Practice Location

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