Basic Information
| Provider Information | |||||||||
| NPI: | 1285037259 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EASTLAND NURSING OPERATIONS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOMESTEAD NURSING AND REHABILITATION OF GORMAN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 W 7TH ST | ||||||||
| Address2: | |||||||||
| City: | FT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761024900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173396177 | ||||||||
| FaxNumber: | 8173396178 | ||||||||
| Practice Location | |||||||||
| Address1: | 306 W 7TH ST | ||||||||
| Address2: | |||||||||
| City: | FT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761024900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173396177 | ||||||||
| FaxNumber: | 8173396178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2014 | ||||||||
| LastUpdateDate: | 10/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | HARRINGTON | ||||||||
| AuthorizedOfficialFirstName: | RYAN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8173396177 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TRINITY HEALTHCARE, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.