Healthcare Provider Details

I. General information

NPI: 1306314539
Provider Name (Legal Business Name): WESTMINSTER MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JACKSON AVE
AUSTIN TX
78731-6056
US

IV. Provider business mailing address

4100 JACKSON AVE
AUSTIN TX
78731-6056
US

V. Phone/Fax

Practice location:
  • Phone: 512-454-4711
  • Fax: 512-454-1389
Mailing address:
  • Phone: 512-454-4711
  • Fax: 512-454-1389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARAH LOYD
Title or Position: ASSOCIATE EXECUTIVE DIRECTOR
Credential:
Phone: 512-600-7313