MEDICARE: SOLID ROCK 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1801056379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLID ROCK INC

Provider Business Mailing Address
First Line	:	1300 DUNDEE DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-3746
Country	:	US
Telephone Number	:	817-789-4966
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 DUNDEE DR
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-3746
Country	:	US
Telephone Number	:	817-789-4966
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. OLATUNJI OLALEYE USMAN
Credential	:
Telephone Number	:	817-344-9159

Provider Enumeration Date	:	06/09/2008
Last Update Date	:	06/09/2008

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Directions to “SOLID ROCK INC ” Practice Location

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