Walnut Creek Residential Services, Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

120445 Issued in TX

Legal business name

WALNUT CREEK RESIDENTIAL SERVICES, INC.

Practice address

622 S Walnut Creek Dr
Mansfield, TX 76063-2132

Phone

(817) 477-3930

Fax

(817) 477-3315

NPI assigned

May 24, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Connie Rogers Leemauk

Title

Administrator

Phone

(817) 477-3930

Specialties & licenses 1

Addresses

Other names 1

• Walnut Creek Doing business as

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174734115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 S WALNUT CREEK DR",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760632132",
            "telephone_number": "817-477-3930",
            "fax_number": "817-477-3315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 S WALNUT CREEK DR",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760632132",
            "telephone_number": "817-477-3930",
            "fax_number": "817-477-3315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALNUT CREEK RESIDENTIAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LEEMAUK",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "ROGERS",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "817-477-3930",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "TX",
            "license": "120445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walnut Creek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kate Walker, PA-C
• Sara Walker, MA
• Erin Elizabeth Wallace, M.D.
• Bailee Ann Waller, M.S., CCC-SLP
• Walnut Creek Counseling PLLC
• Walnut Ridge Orthodontics
• Kaylee Walston
• Joshua Walters, PT, DPT
• Jaden Wang, LAC
• Beth Wangombe

• Intellectual Disabilities Intermediate Care Facility in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Intellectual Disabilities Intermediate Care Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.