<Unavail>

LBN: Providence Park, Inc.
<Unavail> is an health care organization with primary practice located at 300 W Highway 6 , Waco TX 76712-4041. The organization recently has 2 registered licenses in different health care specialties including Nursing & Custodial Care Facilities / Nursing Facility/Intermediate Care Facility, Nursing & Custodial Care Facilities / Skilled Nursing Facility. Nursing & Custodial Care Facilities / Skilled Nursing Facility is the primary health care specialty. Providence Park, Inc. can be contacted via phone (254) 761-8500, or through Shadbolt, Erin via phone (314) 729-3500.

Contact Information

Primary practice address
300 W Highway 6 Waco TX 76712-4041
Phone: (254) 761-8500
Fax: (254) 761-8050
Website:
Map and Directions
Authorized official contact:
Name: Shadbolt, Erin
Phone: (314) 729-3500

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Nursing Facility/Intermediate Care Facility 313M00000X 108085 Texas
Nursing & Custodial Care Facilities / Skilled Nursing Facility 314000000X 108085 Texas

Profile Details

NPI number 1720086655
LBN Legal business name Providence Park, Inc.
DBA Doing business as <Unavail>
Authorized official Shadbolt, Erin
Entity Organization
Organization subpart 1 No
Enumeration date Jul 13th, 2005
Last updated Jun 23rd, 2025 - about last year

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720086655 NPPES
Texas MEDICAID 001026977
Texas Other HH2907
Texas MEDICAID 000530801

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