| NPI | 1770752172 |
|---|---|
| Doing Business As | PROVIDENCE PARK REHABILITATION AND SKILLED NURSING |
| Entity Type | Organization |
| Authorized Contact | LARRY N. PRICE CEO 254-729-3281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: TX 124617) |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2020-04-06 |