Provider Demographics
NPI:1942298146
Name:MCLENNAN COUNTY NURSING HOME
Entity Type:Organization
Organization Name:MCLENNAN COUNTY NURSING HOME
Other - Org Name:QUALITY CARE OF WACO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OF THE GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DICK
Authorized Official - Middle Name:
Authorized Official - Last Name:STEBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:903-757-5360
Mailing Address - Street 1:600 E WHALEY ST
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6525
Mailing Address - Country:US
Mailing Address - Phone:903-757-5360
Mailing Address - Fax:903-753-8621
Practice Address - Street 1:2501 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76707-1337
Practice Address - Country:US
Practice Address - Phone:254-752-3571
Practice Address - Fax:254-752-2005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX004837314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHO4554787Medicaid
TX000483703Medicaid
TX111339102Medicaid
TX111339101Medicaid
TX111339102Medicaid