MEDICARE: WEST SIDE CAMPUS OF CARE LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	116174	TX

General Provider Information

NPI Number	:	1366490856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST SIDE CAMPUS OF CARE LP

Provider Business Mailing Address
First Line	:	1950 LAS VEGAS TRAIL SOUTH
Second Line	:
City	:	WHITE SETTLEMENT
State	:	TX
Zip	:	76108
Country	:	US
Telephone Number	:	817-246-4995
Fax Number	:	817-246-1025

Provider Business Practice Location Address
First Line	:	1950 LAS VEGAS TRAIL SOUTH
Second Line	:
City	:	WHITE SETTLEMENT
State	:	TX
Zip	:	76108
Country	:	US
Telephone Number	:	817-246-4995
Fax Number	:	817-246-1025

Authorized Official
Title or Position	:	SR VICE PRESIDENT OF OPERATIONS
Name	:	EDDIE PARADES
Credential	:
Telephone Number	:	210-493-3165

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	08/22/2020

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