| Organization Name: | WEST 380 NURSING HOME FACILITY |
| NPI Number: | 1407092695 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PAUL OWNES (CHAIRMAN OF BOARD) |
| Mailing Address: | 2108 15th St Bridgeport |
| State: | TX US |
| Postal Code: | 764262055 |
| Phone Number: | 9406835023 |
| Fax Number: | 9406833184 |
| NPI Enumeration Date: | 12/18/2008 |
| NPI Last Update Date: | 12/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251G00000X |
| License Number: | 012018 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Hospice Care, Community Based |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |