Provider Demographics
NPI:1104408301
Name:CASCADES AT JACINTO REHAB, LP
Entity type:Organization
Organization Name:CASCADES AT JACINTO REHAB, LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCSPADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-494-0487
Mailing Address - Street 1:5314 RIVER RUN DR STE 140
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-7706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1405 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77029-2845
Practice Address - Country:US
Practice Address - Phone:713-455-1744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility