Organization
SOUTHWEST LTC - WATERTON LLC
Active
Other names
The Waterton Healthcare & Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD PAYNE (MANAGER)
(469) 916-6100
Entity
Organization
Contact information
Practice address
2875 SHILOH RD, TYLER, TX 75703-2936
(903) 561-1300
(903) 939-1754
Mailing address
5560 TENNYSON PKWY STE 200, PLANO, TX 75024-3582
(469) 916-6100
(469) 916-6105
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103323
—
TX
Enumeration date
03/06/2014
Last updated
02/08/2022
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