Providence Park, Inc.
NPI 1720086655ActiveOrganization· Skilled Nursing Facility· Waco, TX
Skilled Nursing Facility in Waco, Texas, registered in NPPES in July 2005. The authorized official on file is Erin Shadbolt, Ceo. Enrolled in Medicare as part a provider - skilled nursing facility.
Overview
| NPI | 1720086655 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jul 13, 2005 |
| Last updated in NPPES | Jun 23, 2025 |
| Certified by provider | Jun 23, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Skilled Nursing Facility Primary | 314000000X | 108085 | TX |
| Nursing Facility/Intermediate Care Facility | 313M00000X | 108085 | TX |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part A Provider - Skilled Nursing Facility (TX) |
|---|
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