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General NPI Number Information
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NPI Number | 1669463345
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Entity Type | Organization
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Legal Business Name | WICHITA FALLS RETIREMENT FOUNDATION
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 02/27/2009
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Provider Practice Location Address
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Address Line | 3006 MCNIEL AVE
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City | WICHITA FALLS
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State | TX
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Zip | 76309-4954
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Country | US
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Telephone | 940-691-7511
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Fax | 940-696-5154
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Provider Business Mailing Address
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Address Line | 3006 MCNIEL AVE
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City | WICHITA FALLS
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State | TX
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Zip | 76309-4954
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Country | US
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Telephone | 940-691-7511
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Fax | 940-696-5154
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Authorized Official
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Title or Position | ADMINISTRATOR/EXECUTIVE DIRECTOR
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Name | MARSHA CONYEA
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Credential |
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Telephone | 940-691-7511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 109476
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License Number State | TX
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