Healthcare Provider Details

I. General information

NPI: 1033547898
Provider Name (Legal Business Name): WESTON INN SCC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 S 37TH ST
TEMPLE TX
76504-7103
US

IV. Provider business mailing address

600 N PEARL ST STE 1050
DALLAS TX
75201-7495
US

V. Phone/Fax

Practice location:
  • Phone: 254-298-7300
  • Fax: 254-298-7330
Mailing address:
  • Phone: 214-252-7600
  • Fax: 214-252-7704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MICAHEL BEAL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 214-252-7600