Ascension Living Providence Village
LBN: Providence Park, Inc.
Ascension Living Providence Village is an health care organization with primary practice located at 300 W Highway 6 , Waco TX 76712-4041. The organization recently has 2 registered licenses in different health care specialties including Nursing & Custodial Care Facilities / Nursing Facility/Intermediate Care Facility, Nursing & Custodial Care Facilities / Skilled Nursing Facility. Nursing & Custodial Care Facilities / Skilled Nursing Facility is the primary health care specialty.
Providence Park, Inc. can be contacted via phone (254) 761-8500, or through Gronefeld, Kellie via phone (314) 729-3500.
Contact Information
Primary practice address
300 W Highway 6
Waco TX 76712-4041
Phone: (254) 761-8500
Fax: (254) 761-8050
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Nursing & Custodial Care Facilities / Nursing Facility/Intermediate Care Facility | 313M00000X | 108085 | Texas |
| Nursing & Custodial Care Facilities / Skilled Nursing Facility | 314000000X | 108085 | Texas |
Profile Details
| NPI number | 1720086655 |
|---|---|
| LBN Legal business name | Providence Park, Inc. |
| DBA Doing business as | Ascension Living Providence Village |
| Authorized official | Gronefeld, Kellie |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jul 13th, 2005 |
| Last updated | Jun 28th, 2024 - about last year |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1720086655 | NPPES |
| Other | HH2907 | BLUE CROSS BLUE SHIELD | |
| MEDICAID | 001026977 | BLUE CROSS BLUE SHIELD | |
| MEDICAID | 000530801 | BLUE CROSS BLUE SHIELD |
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