# PROVIDENCE PARK, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St. Catherine Center, Ascension Living Providence Village
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720086655
- **Authorized official:** ERIN SHADBOLT (CEO)
- **Authorized official phone:** (314) 729-3500

## Contact information

- **Practice address:** 300 W HIGHWAY 6, WACO, TX 76712-4041
- **Practice address phone:** (254) 761-8500
- **Practice address fax:** (254) 761-8050
- **Mailing address:** 300 W HIGHWAY 6, WACO, TX 76712-4041
- **Mailing address phone:** (254) 761-8500
- **Mailing address fax:** (254) 761-8050

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 108085 | TX | — |
| 314000000X | Skilled Nursing Facility | 108085 | TX | Yes |

## Other

- **Enumeration date:** 07/13/2005
- **Last updated:** 06/23/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000530801 | — | TX |
| 05 | — | 001026977 | — | TX |
| 01 | — | HH2907 | BLUE CROSS BLUE SHIELD | — |