Healthcare Provider Details

I. General information

NPI: 1245962182
Provider Name (Legal Business Name): WACO NURSING AND REHAB CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 LAKE SHORE DR
WACO TX
76708-1276
US

IV. Provider business mailing address

1376 E 3300 S
SALT LAKE CITY UT
84106-3069
US

V. Phone/Fax

Practice location:
  • Phone: 801-601-1450
  • Fax:
Mailing address:
  • Phone: 801-601-1450
  • Fax:

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: DUSTIN MONROE
Title or Position: GENERAL COUNSEL
Credential:
Phone: 385-240-6408