Provider Demographics
NPI:1861613861
Name:CSH WICHITA FALLS LP
Entity type:Organization
Organization Name:CSH WICHITA FALLS LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-287-3992
Mailing Address - Street 1:5100 KELL BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1746
Mailing Address - Country:US
Mailing Address - Phone:940-691-8181
Mailing Address - Fax:
Practice Address - Street 1:5102 W LAUREL ST STE 700
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-3854
Practice Address - Country:US
Practice Address - Phone:813-287-3992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility