| NPI | 1508254046 |
|---|---|
| Doing Business As | PROVIDENCE PARK REHABILITATION AND SKILLED NURSING |
| Entity Type | Organization |
| Authorized Contact | MICHAEL MCANDREW CEO 903-439-4952 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2015-01-07 |
| Last Update Date | 2015-01-07 |