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Organization
MASON ROUND ROCK OP LLC
Active
Organization
MASON ROUND ROCK OP LLC
Active
Other names
San Gabriel Rehabilitation and Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL A. LITTLE (ADMINISTRATOR)
(512) 334-8000
Entity
Organization
Contact information
Practice address
4100 COLLEGE PARK DRIVE, ROUND ROCK, TX 78665-1522
(512) 334-8000
(512) 334-8005
Mailing address
4100 COLLEGE PARK DRIVE, ROUND ROCK, TX 78665-1522
(512) 334-8000
(512) 334-8005
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
133434
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001020004
—
TX
01
—
105009
FACILITY ID
TX
Enumeration date
10/04/2011
Last updated
09/27/2012
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