Basic Information
| Provider Information | |||||||||
| NPI: | 1649834185 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KPC PROMISE SKILLED NURSING FACILITY OF WICHITA FALLS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 N FEDERAL HWY STE 350 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334322754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618696505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1101 GRACE ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763014414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9407206633 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2019 | ||||||||
| LastUpdateDate: | 11/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 9519878100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.