Provider Demographics
NPI:1578998605
Name:LUFKIN SNF LLC
Entity Type:Organization
Organization Name:LUFKIN SNF LLC
Other - Org Name:PARKWOOD PLACE HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-637-7215
Mailing Address - Street 1:200 W STATE HIGHWAY 6
Mailing Address - Street 2:SUITE 612
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7923
Mailing Address - Country:US
Mailing Address - Phone:254-399-6788
Mailing Address - Fax:254-399-6766
Practice Address - Street 1:300 N BYNUM ST
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-2707
Practice Address - Country:US
Practice Address - Phone:936-637-7215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX455673Medicare Oscar/Certification