Healthcare Provider Details

I. General information

NPI: 1568070001
Provider Name (Legal Business Name): SLP WILLIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2020
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N DANVILLE ST
WILLIS TX
77378-3490
US

IV. Provider business mailing address

3000 N DANVILLE ST
WILLIS TX
77378-3490
US

V. Phone/Fax

Practice location:
  • Phone: 936-856-4312
  • Fax: 936-856-4364
Mailing address:
  • Phone: 936-856-4312
  • Fax: 936-856-4364

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: RICHARD AGNEW
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 512-565-6159