Provider Demographics
NPI:1437458254
Name:WSE ENTERPRISES LLC
Entity Type:Organization
Organization Name:WSE ENTERPRISES LLC
Other - Org Name:THROCKMORTON NURSING & REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-948-3966
Mailing Address - Street 1:1724 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76110-6407
Mailing Address - Country:US
Mailing Address - Phone:817-948-3966
Mailing Address - Fax:940-228-4183
Practice Address - Street 1:1000 N MINTER AVE
Practice Address - Street 2:
Practice Address - City:THROCKMORTON
Practice Address - State:TX
Practice Address - Zip Code:76483-4900
Practice Address - Country:US
Practice Address - Phone:940-849-2861
Practice Address - Fax:940-849-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
004246OtherFACILITY ID