Provider Demographics
NPI:1669463345
Name:WICHITA FALLS RETIREMENT FOUNDATION
Entity Type:Organization
Organization Name:WICHITA FALLS RETIREMENT FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONYEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-691-7511
Mailing Address - Street 1:3006 MCNIEL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-4954
Mailing Address - Country:US
Mailing Address - Phone:940-691-7511
Mailing Address - Fax:940-696-5154
Practice Address - Street 1:3006 MCNIEL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-4954
Practice Address - Country:US
Practice Address - Phone:940-691-7511
Practice Address - Fax:940-696-5154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109476313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001016429Medicaid