South Park Care & Rehab LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SOUTH PARK CARE & REHAB LLC

Practice address

2450 E 5TH St
Tyler, TX 75701-3525

Phone

(817) 557-2221

NPI assigned

Dec 14, 2012

Last updated

Dec 14, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jason Quick

Title

Controller

Phone

(817) 557-2221

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1355443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355443200000",
    "number": "1326384538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5519 S COLLINS ST",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760181705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 E 5TH ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757013525",
            "telephone_number": "817-557-2221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PARK CARE & REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-14",
        "last_updated": "2012-12-14",
        "status": "A",
        "authorized_official_last_name": "QUICK",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "817-557-2221"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5390",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Glen W Sorrentino, MD
• Michael Anthony Sorto, M.D.
• Brianna Souder, DO
• South Limestone Hospital District (Briarcliff Health Center)
• South Limestone Hospital District (Providence Park Rehabilitation and Skilled Nursing)
• South Tyler Dermatology
• South Tyler Family Dentistry PLLC (Fresh Dental and Orthodontics)
• Southland Legend Pharmacy
• Southwest LTC - Reunion Plaza LLC (Reunion Plaza Healthcare & Rehabilitation)
• Southwest LTC - Waterton LLC (The Waterton Healthcare & Rehabilitation)

• Skilled Nursing Facility in Tyler, TX
• Providers in Tyler, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.