Organization
CONVACARE INC
Active
Other names
Lakeridge Rehabliltation and Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RICHARD RUBLE (PRESIDENT)
(806) 780-7000
Entity
Organization
Contact information
Practice address
4403 74TH ST, LUBBOCK, TX 79424-2307
(806) 795-0668
(806) 795-4250
Mailing address
4403 74TH ST, LUBBOCK, TX 79424-2307
(806) 795-0668
(806) 795-4250
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
109070
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001001028
—
TX
05
—
171013901
—
TX
05
—
4942
—
TX
Enumeration date
05/23/2005
Last updated
04/29/2010
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