# SOUTHWEST LTC CROCKETT I, LTD.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Whitehall Nursing Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487726329
- **Authorized official:** RONALD R. PAYNE (MANAGING MEMBER)
- **Authorized official phone:** (469) 916-6100

## Contact information

- **Practice address:** 1116 EAST LOOP 304, CROCKETT, TX 75835-1810
- **Practice address phone:** (469) 916-6100
- **Practice address fax:** (469) 916-6105
- **Mailing address:** 17760 PRESTON RD, SUITE 310, DALLAS, TX 75252-5663
- **Mailing address phone:** (469) 916-6100
- **Mailing address fax:** (469) 916-6105

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | TX | Yes |

## Other

- **Enumeration date:** 11/15/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4428 | — | TX |