Basic Information
| Provider Information | |||||||||
| NPI: | 1952748956 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RUSK NURSING & REHAB CENTER LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CHEROKEE TRAILS NURSING HOME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 403 E COMMERCE ST | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 758401603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033891009 | ||||||||
| FaxNumber: | 9033891090 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 BAGLEY RD | ||||||||
| Address2: | |||||||||
| City: | RUSK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757851930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036835438 | ||||||||
| FaxNumber: | 9036838418 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2013 | ||||||||
| LastUpdateDate: | 05/06/2015 | ||||||||
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| AuthorizedOfficialLastName: | BLALOCK | ||||||||
| AuthorizedOfficialFirstName: | BEVERLY | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2547445249 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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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.