# SOUTHWEST LTC KILGORE LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Willows of Kilgore
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619287273
- **Authorized official:** RONALD R PAYNE (MANAGER)
- **Authorized official phone:** (469) 916-6100

## Contact information

- **Practice address:** 1901 WHIPPORWILL LN, KILGORE, TX 75662-3880
- **Practice address phone:** (903) 983-7775
- **Practice address fax:** (903) 984-2244
- **Mailing address:** 1901 WHIPPORWILL LN, KILGORE, TX 75662-3880
- **Mailing address phone:** (903) 983-7775
- **Mailing address fax:** (903) 984-2244

## Taxonomy

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

## Other

- **Enumeration date:** 10/18/2010
- **Last updated:** 11/08/2010