MEDICARE: WILLIS NURSING AND REHABILITATION 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	156655601	OTHER	TX	TMHP (CROSS-OVER)

General Provider Information

NPI Number	:	1770579559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIS NURSING AND REHABILITATION LP

Provider Business Mailing Address
First Line	:	419 S ELM ST
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-6085
Country	:	US
Telephone Number	:	940-387-4388
Fax Number	:	940-380-2410

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	:	CEO
Name	:	MR. DAN D FLAGG
Credential	:
Telephone Number	:	940-387-4388

Provider Enumeration Date	:	09/27/2005
Last Update Date	:	02/12/2019

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Directions to “WILLIS NURSING AND REHABILITATION LP ” Practice Location

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