| Organization Name: | ROCKDALE BLACKHAWK LLC |
| NPI Number: | 1699798512 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFREY P MADISON (CEO) |
| Mailing Address: | 602 N Main St Rockdale |
| State: | TX US |
| Postal Code: | 765672323 |
| Phone Number: | 5124464500 |
| Fax Number: | 5124460084 |
| NPI Enumeration Date: | 07/25/2006 |
| NPI Last Update Date: | 02/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 000369 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |