Basic Information
| Provider Information | |||||||||
| NPI: | 1609132794 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CAMP WOOD SNF, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CEDAR HILLS GERIATRIC CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 830 | ||||||||
| Address2: | |||||||||
| City: | CAMP WOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788330830 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8305975445 | ||||||||
| FaxNumber: | 8773349483 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 HWY 55 | ||||||||
| Address2: | |||||||||
| City: | CAMP WOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8305975445 | ||||||||
| FaxNumber: | 8773349483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2012 | ||||||||
| LastUpdateDate: | 05/10/2012 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROBINSON | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5128512273 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.