Organization
ROCKDALE BLACKHAWK, LLC
Active
Parent organization
ROCKDALE BLACKHAWK, LLC
Other names
LIttle River Healthcare - Family Care Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
ROCKDALE BLACKHAWK, LLC
Authorized official
JEFFREY P MADISON (CEO)
(512) 446-4500
Entity
Organization
Contact information
Practice address
1700 BRAZOS, SUITE A, B AND C, ROCKDALE, TX 76567
(512) 446-4500
(512) 446-0084
Mailing address
P.O. BOX 1010, ROCKDALE, TX 76567
(512) 446-4500
(512) 446-0084
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
321720001
—
TX
Enumeration date
11/07/2011
Last updated
04/09/2015
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