Basic Information
| Provider Information | |||||||||
| NPI: | 1588863757 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEER CREEK OF WIMBERLY NURSING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 RANCH ROAD 3237 | ||||||||
| Address2: | |||||||||
| City: | WIMBERLEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786765311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128475540 | ||||||||
| FaxNumber: | 5128470419 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 RANCH RD 3237 | ||||||||
| Address2: | |||||||||
| City: | WIMBERLY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128475540 | ||||||||
| FaxNumber: | 5128470419 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2007 | ||||||||
| LastUpdateDate: | 07/17/2007 | ||||||||
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| AuthorizedOfficialLastName: | ACHEE | ||||||||
| AuthorizedOfficialFirstName: | ZANNA | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 5128475540 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | PTA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 2004214 | TX | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.