Provider Demographics
NPI:1457950628
Name:WATAUGA I ENTERPRISES, LLC
Entity Type:Organization
Organization Name:WATAUGA I ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF ACCOUNTS RECEIVABLE
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-348-8959
Mailing Address - Street 1:4150 INTERNATIONAL PLZ STE 600
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4831
Mailing Address - Country:US
Mailing Address - Phone:817-348-8959
Mailing Address - Fax:817-348-0466
Practice Address - Street 1:7804 VIRGIL ANTHONY BLVD
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2456
Practice Address - Country:US
Practice Address - Phone:817-498-7220
Practice Address - Fax:817-500-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility