Provider Demographics
NPI:1871581439
Name:WINNIE L. NURSING FACILITY
Entity type:Organization
Organization Name:WINNIE L. NURSING FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:VOGELSANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-697-4985
Mailing Address - Street 1:2104 N KARNES AVE
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:TX
Mailing Address - Zip Code:76520-1055
Mailing Address - Country:US
Mailing Address - Phone:254-697-4985
Mailing Address - Fax:254-697-2129
Practice Address - Street 1:2104 N KARNES AVE
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:TX
Practice Address - Zip Code:76520-1055
Practice Address - Country:US
Practice Address - Phone:254-697-4985
Practice Address - Fax:254-697-2129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109457313M00000X
TX115833314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45F240Medicaid
TX45F240Medicaid