Provider Demographics
NPI:1750376273
Name:WOODLAND SPRINGS NURSING CENTER INC
Entity type:Organization
Organization Name:WOODLAND SPRINGS NURSING CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:BUMPASS
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:254-399-6788
Mailing Address - Street 1:200 W HIGHWAY 6
Mailing Address - Street 2:SUITE 509
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 1:1405 W STOREY ST
Practice Address - Street 2:
Practice Address - City:SAN SABA
Practice Address - State:TX
Practice Address - Zip Code:76877-6422
Practice Address - Country:US
Practice Address - Phone:254-372-5112
Practice Address - Fax:254-372-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114176313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140720701Medicaid
TX140720701Medicaid