Provider Demographics
NPI:1649834185
Name:KPC PROMISE SKILLED NURSING FACILITY OF WICHITA FALLS LLC
Entity type:Organization
Organization Name:KPC PROMISE SKILLED NURSING FACILITY OF WICHITA FALLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-987-8100
Mailing Address - Street 1:900 N FEDERAL HWY STE 350
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-2754
Mailing Address - Country:US
Mailing Address - Phone:561-869-6505
Mailing Address - Fax:
Practice Address - Street 1:1101 GRACE ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4414
Practice Address - Country:US
Practice Address - Phone:940-720-6633
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility