MEDICARE: WHITEHALL NURSING CENTER, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	115369	TX

General Provider Information

NPI Number	:	1215902440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITEHALL NURSING CENTER, LTD

Provider Business Mailing Address
First Line	:	PO BOX 998
Second Line	:
City	:	CROCKETT
State	:	TX
Zip	:	75835-0998
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1116 E LOOP 304
Second Line	:
City	:	CROCKETT
State	:	TX
Zip	:	75835-1810
Country	:	US
Telephone Number	:	936-544-2163
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ROBERT WINFIELD
Credential	:
Telephone Number	:	936-544-2163

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	08/22/2020

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