Provider Demographics
NPI:1043240096
Name:WIND CREST NURSING CENTER INC
Entity Type:Organization
Organization Name:WIND CREST NURSING CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCULLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-646-5951
Mailing Address - Street 1:607 W AVENUE B
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-1553
Mailing Address - Country:US
Mailing Address - Phone:254-547-1033
Mailing Address - Fax:254-542-3506
Practice Address - Street 1:607 W AVENUE B
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-1553
Practice Address - Country:US
Practice Address - Phone:254-547-1033
Practice Address - Fax:254-542-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168093140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000515401Medicaid
TX021431401Medicaid
TX455515Medicare Oscar/Certification