Provider Demographics
NPI:1275962870
Name:WICHITA FALLS OPERATING COMPANY LLC
Entity Type:Organization
Organization Name:WICHITA FALLS OPERATING COMPANY LLC
Other - Org Name:GRACE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP OPERATIONS FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:SIMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-443-7000
Mailing Address - Street 1:1101 GRACE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-4414
Mailing Address - Country:US
Mailing Address - Phone:940-322-3393
Mailing Address - Fax:
Practice Address - Street 1:5300 W SAM HOUSTON PKWY N
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-5161
Practice Address - Country:US
Practice Address - Phone:832-467-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX455901Medicare Oscar/Certification