Healthcare Provider Details

I. General information

NPI: 1497737472
Provider Name (Legal Business Name): WESTMINSTER MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/28/2019
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: 124-542-1405
  • Fax: 512-458-5713
Mailing address:
  • Phone: 512-454-2140
  • Fax: 512-458-5713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000176
License Number StateTX

VIII. Authorized Official

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