1760851323 NPI number — WINTERS HC OPERATOR LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760851323 NPI number — WINTERS HC OPERATOR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WINTERS HC OPERATOR LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WINTERS HEALTHCARE RESIDENCE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760851323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 CLIFTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08701-3342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-396-3462
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 VAN NESS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTERS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79567-4724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-754-4566
Provider Business Practice Location Address Fax Number:
325-754-4634
Provider Enumeration Date:
09/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FALKINBURG
Authorized Official First Name:
KARIN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE ASSISTANT
Authorized Official Telephone Number:
214-396-3462

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001027624 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 67-5847 . This is a "MEDICARE ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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