MEDICARE: SLP WILLIS LLC

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

General Provider Information

NPI Number	:	1568070001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLP WILLIS LLC

Provider Business Mailing Address
First Line	:	3000 N DANVILLE ST
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-3490
Country	:	US
Telephone Number	:	936-856-4312
Fax Number	:	936-856-4364

Provider Business Practice Location Address
First Line	:	3000 N DANVILLE ST
Second Line	:
City	:	WILLIS
State	:	TX
Zip	:	77378-3490
Country	:	US
Telephone Number	:	936-856-4312
Fax Number	:	936-856-4364

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	RICHARD AGNEW
Credential	:
Telephone Number	:	512-565-6159

Provider Enumeration Date	:	07/21/2020
Last Update Date	:	06/30/2025

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Directions to “SLP WILLIS LLC ” Practice Location

Language	Start Address	Practice Location

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