Type 2 · Organization ✓ Active NPI ✓ Valid NPI checksum

Providence Park, Inc.

Q: What type of organization is Providence Park, Inc.?

Providence Park, Inc. is registered in NPPES as a Skilled Nursing Facility (its primary provider taxonomy).

Skilled Nursing Facility in Waco, TX · enumerated 2005 · authorized official Erin Shadbolt, Ceo.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1720086655

Verified

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Registry record

Entity type Organization (Type 2)

Legal business name Providence Park, Inc.

Other name <Unavail>

Practice address 300 W Highway 6, Waco, TX, 76712

Phone (254) 761-8500

Fax (254) 761-8050

Enumeration date Jul 13, 2005

Last updated in NPPES Jun 23, 2025

Taxonomy & classification

313M00000X Nursing Facility/Intermediate Care Facility Nursing & Custodial Care Facilities · License 108085 (TX) Secondary

314000000X Skilled Nursing Facility Nursing & Custodial Care Facilities · License 108085 (TX) Primary

Authorized official

Name Erin Shadbolt

Title Ceo

Phone (314) 729-3500

Other identifiers

Identifier	Type	State	Issuer
001026977	Medicaid	TX	-
HH2907	Other	-	BLUE CROSS BLUE SHIELD
000530801	Medicaid	TX	-

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

Read the full guide → Validate an NPI →

Frequently asked questions

What type of organization is Providence Park, Inc.?

Providence Park, Inc. is registered in NPPES as a Skilled Nursing Facility (its primary provider taxonomy).

What is a Type 2 NPI?

A Type 2 NPI identifies an organization (group practice, hospital, pharmacy, lab), while Type 1 NPIs identify individual providers. Organizations bill under their Type 2 NPI.

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Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2025-06-23.