Basic Information
| Provider Information | |||||||||
| NPI: | 1851722359 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROMISE SKILLED NURSING FACILITY OF WICHITA FALLS INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 999 YAMATO RD | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334314477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618693100 | ||||||||
| FaxNumber: | 5618260171 | ||||||||
| 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: | 12/09/2013 | ||||||||
| LastUpdateDate: | 03/01/2018 | ||||||||
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| AuthorizedOfficialLastName: | HOPWOOD | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5618693100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PROMISE HEALTHCARE #2 INC. | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.