Provider Demographics
NPI: | 1902408156 |
---|---|
Name: | FLINTROCK FALLS HEALTHCARE, INC. |
Entity Type: | Organization |
Organization Name: | FLINTROCK FALLS HEALTHCARE, INC. |
Other - Org Name: | LAKEWAY SKILLED NURSING AND REHABILITATION |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | TREASURER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SOON |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BURNAM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 949-540-1249 |
Mailing Address - Street 1: | 1917 LOHMANS CROSSING RD |
Mailing Address - Street 2: | |
Mailing Address - City: | LAKEWAY |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78734-5269 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 512-261-3211 |
Mailing Address - Fax: | 512-261-7147 |
Practice Address - Street 1: | 1917 LOHMANS CROSSING RD |
Practice Address - Street 2: | |
Practice Address - City: | LAKEWAY |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78734-5269 |
Practice Address - Country: | US |
Practice Address - Phone: | 512-261-3211 |
Practice Address - Fax: | 512-261-7147 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-11-12 |
Last Update Date: | 2020-11-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 314000000X | Nursing & Custodial Care Facilities | Skilled Nursing Facility |