MEDICARE: WINDCREST OPCO LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1285580043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINDCREST OPCO LLC

Provider Business Mailing Address
First Line	:	702 W WINDCREST DR
Second Line	:
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-4680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 W WINDCREST DR
Second Line	:
City	:	FREDERICKSBURG
State	:	TX
Zip	:	78624-4680
Country	:	US
Telephone Number	:	830-856-2450
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED SIGNATORY
Name	:	FRANK SMALL
Credential	:
Telephone Number	:	917-825-8194

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “WINDCREST OPCO LLC ” Practice Location

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