# RIO ONE AT TARRANT COUNTY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Lodge at Bear Creek
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083088959
- **Authorized official:** MRS. KELLEY WHITAKER (CHIEF OPERATIONS OFFICER)
- **Authorized official phone:** (505) 369-0079

## Contact information

- **Practice address:** 3729 IRA E WOODS AVE, GRAPEVINE, TX 76051-4213
- **Practice address phone:** (817) 809-8000
- **Mailing address:** 8820 HORIZON BLVD NE, ALBUQUERQUE, NM 87113-1689
- **Mailing address phone:** (505) 369-0079

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 11/16/2015
- **Last updated:** 08/22/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001027384 | — | TX |
| 01 | — | 802160926 | STATE LICENSE | TX |