=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871581439
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WINNIE L. NURSING FACILITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2005
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2104 N KARNES AVE
-----------------------------------------------------
City | CAMERON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76520-1055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-697-4985
-----------------------------------------------------
Fax | 254-697-2129
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2104 N KARNES AVE
-----------------------------------------------------
City | CAMERON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76520-1055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-697-4985
-----------------------------------------------------
Fax | 254-697-2129
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. FREDERICK JAMES VOGELSANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 254-697-4985
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | 109457
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 115833
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------