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General NPI Number Information
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NPI Number | 1861613861
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Entity Type | Organization
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Legal Business Name | CSH WICHITA FALLS LP
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5102 W LAUREL ST STE 700
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City | TAMPA
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State | FL
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Zip | 33607-3854
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Country | US
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Telephone | 813-287-3992
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Fax |
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Provider Business Mailing Address
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Address Line | 5100 KELL BLVD
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City | WICHITA FALLS
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State | TX
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Zip | 76310-1746
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Country | US
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Telephone | 940-691-8181
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JON A. DELUCA
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Credential |
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Telephone | 813-287-3992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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