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Providence Park, Inc.
Skilled Nursing Facility in Waco, Texas
NPI 1720086655

Providence Park, Inc. is a Skilled Nursing Facility based in Waco, TX. Providence Park, Inc. practices in Waco, TX. The NPI Number for Providence Park, Inc. is 1720086655 and holds a License No. 108085 (Texas).

The current practice location address for Providence Park, Inc. is 300 W Highway 6, Waco, TX and can be reached out via phone at 254-761-8500 and via fax at 254-761-8050.

Location: 300 W Highway 6, Waco, TX, 76712-4041
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1720086655
Provider Name
Providence Park, Inc.
Credential
Provider Entity Type
Organization
Address
300 W Highway 6, Waco, TX, 76712-4041
Phone Number
254-761-8500
Fax Number
254-761-8050
Provider Enumeration Date
07/13/2005
Last Update Date
07/20/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
HH2907 01 BLUE CROSS BLUE SHIELD
001026977 05 TX
000530801 05 TX
institution
Provider Business Practice Location Address Details
Address
300 W Highway 6
City
Waco
State
Texas
Zip
76712-4041
Phone Number
254-761-8500
Fax Number
254-761-8050
person
Provider Business Mailing Address Details
Address
300 W Highway 6
City
Waco
State
Texas
Zip
76712-4041
Phone Number
254-761-8500
Fax Number
254-761-8050
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Nursing Facility/Intermediate Care Facility
Speciality
-
Taxonomy
313M00000X
License No.
108085 (Texas)
Definition
An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.
person
Provider's Taxonomy Details 2
Type
Nursing & Custodial Care Facilities
Classification
Skilled Nursing Facility
Speciality
-
Taxonomy
314000000X
License No.
108085 (Texas)
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
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