Basic Information
| Provider Information | |||||||||
| NPI: | 1407102601 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CALDWELL NURSING AND REHAB CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COPPERAS HOLLOW NURSING AND REHAB CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6340 S 3000 E | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841213540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016011450 | ||||||||
| FaxNumber: | 8019963601 | ||||||||
| Practice Location | |||||||||
| Address1: | 345 COUNTRY CLUB DR | ||||||||
| Address2: | |||||||||
| City: | CALDWELL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 778362328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9795676400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2012 | ||||||||
| LastUpdateDate: | 07/25/2012 | ||||||||
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| AuthorizedOfficialLastName: | RAMOS | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8016011450 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 134610 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.