Waco Healthcare Residence LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

WACO HEALTHCARE RESIDENCE LLC

Practice address

1400 Lake Shore Dr
Waco, TX 76708-3718

Phone

(254) 753-0291

Fax

(254) 753-3343

NPI assigned

Jun 11, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joe Neuman

Title

Manager

Phone

(888) 396-3462

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Crestview Nursing and Rehab Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1164081352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 CLIFTON AVE",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087013342",
            "telephone_number": "888-396-3462",
            "fax_number": "214-396-3462"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 LAKE SHORE DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767083718",
            "telephone_number": "254-753-0291",
            "fax_number": "254-753-3343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WACO HEALTHCARE RESIDENCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-11",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "NEUMAN",
        "authorized_official_first_name": "JOE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "888-396-3462"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE FACILITY ID",
            "identifier": "004025",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crestview Nursing and Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Waco, TX
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.