Healthcare Provider Details

I. General information

NPI: 1295777902
Provider Name (Legal Business Name): WEST 380 NURSING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 15TH ST
BRIDGEPORT TX
76426
US

IV. Provider business mailing address

2108 15TH STREET
BRIDGEPORT TX
76426
US

V. Phone/Fax

Practice location:
  • Phone: 940-683-5023
  • Fax: 940-683-3184
Mailing address:
  • Phone: 940-683-5023
  • Fax: 940-683-3184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: PAUL OWENS
Title or Position: CHAIRMAN OF BOARD
Credential:
Phone: 940-683-5283