Basic Information
| Provider Information | |||||||||
| NPI: | 1487185732 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COTTONWOOD LONG TERM CARE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CEDAR POINTE HEALTH AND WELLNESS SUITES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 COTTONWOOD CREEK TRL | ||||||||
| Address2: | |||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786132091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7377573100 | ||||||||
| FaxNumber: | 7377573101 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 COTTONWOOD CREEK TRAIL | ||||||||
| Address2: | |||||||||
| City: | CEDAR PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107731000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2017 | ||||||||
| LastUpdateDate: | 10/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | BLASIG | ||||||||
| AuthorizedOfficialFirstName: | RON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7377573100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.