Provider Demographics
NPI:1588863757
Name:DEER CREEK OF WIMBERLY NURSING CENTER
Entity type:Organization
Organization Name:DEER CREEK OF WIMBERLY NURSING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:ZANNA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ACHEE
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:512-847-5540
Mailing Address - Street 1:555 RANCH ROAD 3237
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-5311
Mailing Address - Country:US
Mailing Address - Phone:512-847-5540
Mailing Address - Fax:512-847-0419
Practice Address - Street 1:555 RANCH RD 3237
Practice Address - Street 2:
Practice Address - City:WIMBERLY
Practice Address - State:TX
Practice Address - Zip Code:78676
Practice Address - Country:US
Practice Address - Phone:512-847-5540
Practice Address - Fax:512-847-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2004214314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility