Organization
SOUTH PARK CARE & REHAB LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON QUICK (CONTROLLER)
(817) 557-2221
Entity
Organization
Contact information
Practice address
2450 E 5TH ST, TYLER, TX 75701-3525
(817) 557-2221
Mailing address
5519 S COLLINS ST, ARLINGTON, TX 76018-1705
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5390
—
TX
Enumeration date
12/14/2012
Last updated
12/14/2012
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