Charleston Waco Operations LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

136593 Issued in TX

Legal business name

CHARLESTON WACO OPERATIONS LLC

Practice address

1010 Dallas St
Waco, TX 76704-1711

Phone

(337) 439-6600

Fax

(337) 439-6647

NPI assigned

Oct 16, 2013

Organization subpart

No

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

Authorized official

Name

Kendall A Broussard

Title

Managing Member

Phone

(337) 439-6600

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Woodland Springs Nursing Center Doing business as

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

{
    "created_epoch": "1381881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386720000000",
    "number": "1669800371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 W BROAD ST STE 800",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706014297",
            "telephone_number": "337-439-6600",
            "fax_number": "337-439-6647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 DALLAS ST",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767041711",
            "telephone_number": "337-439-6600",
            "fax_number": "337-439-6647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLESTON WACO OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-16",
        "last_updated": "2013-12-11",
        "status": "A",
        "authorized_official_last_name": "BROUSSARD",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "337-439-6600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "136593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004029",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001025526",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4029",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodland Springs Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristen Jewell Chapman, MS,LAT,ATC
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• Jaime A Chavez, BT

• Skilled Nursing Facility in Waco, TX
• Providers in Waco, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; 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.