Basic Information
| Provider Information | |||||||||
| NPI: | 1588815203 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTHCARE AND REHAB OF KINGSTON, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HEALTHCARE AND REHAB OF KINGSTON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7429 AIRPORT FWY | ||||||||
| Address2: | |||||||||
| City: | RICHLAND HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761186955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175954411 | ||||||||
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| Practice Location | |||||||||
| Address1: | HC 71 BOX 83 | ||||||||
| Address2: | |||||||||
| City: | KINGSTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 734399701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5805642216 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2008 | ||||||||
| LastUpdateDate: | 03/01/2010 | ||||||||
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| AuthorizedOfficialLastName: | HEAD | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8179922028 | ||||||||
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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.