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General NPI Number Information
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NPI Number | 1588863757
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Entity Type | Organization
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Legal Business Name | DEER CREEK OF WIMBERLY NURSING CENTER
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Dates
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Enumeration Date | 07/17/2007
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Last Update Date | 07/17/2007
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Provider Practice Location Address
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Address Line | 555 RANCH RD 3237
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City | WIMBERLY
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State | TX
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Zip | 78676
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Country | US
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Telephone | 512-847-5540
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Fax | 512-847-0419
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Provider Business Mailing Address
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Address Line | 555 RANCH ROAD 3237
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City | WIMBERLEY
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State | TX
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Zip | 78676-5311
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Country | US
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Telephone | 512-847-5540
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Fax | 512-847-0419
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Authorized Official
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Title or Position | PHYSICAL THERAPIST ASSISTANT
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Name | MS. ZANNA LEE ACHEE
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Credential | PTA
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Telephone | 512-847-5540
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2004214
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License Number State | TX
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