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Organization
MSPF-IV GRAPEVINE OE, LP
Active
Organization
MSPF-IV GRAPEVINE OE, LP
Active
Other names
Lone Star Comprehensive Adult Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID RONCK (MANAGER)
(214) 651-4050
Entity
Organization
Contact information
Practice address
1005 IRA E WOODS AVE, GRAPEVINE, TX 76051-4018
(817) 796-4621
(817) 796-4629
Mailing address
3811 TURTLE CREEK BLVD, SUITE #1850, DALLAS, TX 75219-4402
(214) 651-4050
(214) 651-4001
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
117706
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5471
MEDICAID VENDOR
TX
Enumeration date
03/13/2008
Last updated
04/07/2008
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