Organization
SOUTHWEST LTC CROCKETT I, LTD.
Active
Other names
Whitehall Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD R. PAYNE (MANAGING MEMBER)
(469) 916-6100
Entity
Organization
Contact information
Practice address
1116 EAST LOOP 304, CROCKETT, TX 75835-1810
(469) 916-6100
(469) 916-6105
Mailing address
17760 PRESTON RD, SUITE 310, DALLAS, TX 75252-5663
(469) 916-6100
(469) 916-6105
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4428
—
TX
Enumeration date
11/15/2006
Last updated
08/22/2020
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