Healthcare Provider Details

I. General information

NPI: 1457950628
Provider Name (Legal Business Name): WATAUGA I ENTERPRISES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7804 VIRGIL ANTHONY BLVD
WATAUGA TX
76148-2456
US

IV. Provider business mailing address

4150 INTERNATIONAL PLZ STE 200
FORT WORTH TX
76109-4875
US

V. Phone/Fax

Practice location:
  • Phone: 817-498-7220
  • Fax: 817-500-0108
Mailing address:
  • Phone: 817-348-8959
  • Fax: 817-348-0466

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: LINDA HUGGINS
Title or Position: VP OF ACCOUNTS RECEIVABLE
Credential:
Phone: 817-348-8959