Healthcare Provider Details

I. General information

NPI: 1275521460
Provider Name (Legal Business Name): WALNUT HILLS NURSING AND REHABILITATION, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 ROGGE LN
AUSTIN TX
78723-3640
US

IV. Provider business mailing address

600 E WHALEY ST
LONGVIEW TX
75601-6525
US

V. Phone/Fax

Practice location:
  • Phone: 512-926-2070
  • Fax: 512-926-9570
Mailing address:
  • Phone: 903-757-5360
  • Fax: 903-753-8621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number111191
License Number StateTX

VIII. Authorized Official

Name: DICK STEBBINS
Title or Position: PRESIDENT
Credential: CPA
Phone: 903-757-5360