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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