Organization
RIO ONE AT TARRANT COUNTY, LLC
Active
Other names
The Lodge at Bear Creek
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLEY WHITAKER (CHIEF OPERATIONS OFFICER)
(505) 369-0079
Entity
Organization
Contact information
Practice address
3729 IRA E WOODS AVE, GRAPEVINE, TX 76051-4213
(817) 809-8000
Mailing address
8820 HORIZON BLVD NE, ALBUQUERQUE, NM 87113-1689
(505) 369-0079
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001027384
—
TX
01
—
802160926
STATE LICENSE
TX
Enumeration date
11/16/2015
Last updated
08/22/2016
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