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Organization
CHARLESTON WACO OPERATIONS LLC
Active
Organization
CHARLESTON WACO OPERATIONS LLC
Active
Other names
Woodland Springs Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
KENDALL A BROUSSARD (MANAGING MEMBER)
(337) 439-6600
Entity
Organization
Contact information
Practice address
1010 DALLAS ST, WACO, TX 76704-1711
(337) 439-6600
(337) 439-6647
Mailing address
127 W BROAD ST STE 800, LAKE CHARLES, LA 70601-4297
(337) 439-6600
(337) 439-6647
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
136593
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001025526
—
TX
05
—
004029
—
TX
05
—
4029
—
TX
Enumeration date
10/16/2013
Last updated
12/11/2013
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