Healthcare Provider Details

I. General information

NPI: 1477937068
Provider Name (Legal Business Name): WACO SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WOODGATE DR
WACO TX
76712-8600
US

IV. Provider business mailing address

2071 FLATBUSH AVE SUITE 22
BROOKLYN NY
11234-4340
US

V. Phone/Fax

Practice location:
  • Phone: 254-666-5454
  • Fax: 254-666-5459
Mailing address:
  • Phone: 718-338-2999
  • Fax: 718-338-3837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ELIEZER SCHEINER
Title or Position: MEMBER
Credential:
Phone: 718-338-2999