Providence Park, Inc.
Providence Park, Inc. is a healthcare organization registered as Skilled Nursing Facility in Waco, TX, holding Type 2 (organization) NPI 1720086655 since 2005. The authorized official on file is Erin Shadbolt, Ceo.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1720086655 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Providence Park, Inc. |
| Other name | <Unavail> |
| Practice address | 300 W HIGHWAY 6, Waco, TX, 76712 |
| Phone | 2547618500 |
| Fax | 2547618050 |
| Enumeration date | 2005-07-13 |
| Last updated in NPPES | 2025-06-23 |
Authorized official
| Name | Erin Shadbolt |
|---|---|
| Title | Ceo |
| Phone | 3147293500 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 313M00000X | Nursing Facility/Intermediate Care Facility | Secondary | 108085 | TX |
| 314000000X | Skilled Nursing Facility | Primary | 108085 | TX |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001026977 | Medicaid | TX | — |
| HH2907 | Other | — | BLUE CROSS BLUE SHIELD |
| 000530801 | Medicaid | TX | — |
Copy-ready billing details
Provider: Providence Park, Inc. NPI: 1720086655 Taxonomy: 314000000X (Skilled Nursing Facility) Address: 300 W HIGHWAY 6, Waco, TX, 76712
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1477034916 | Melissa Valerio | Individual | Occupational Therapy Assistant | Waco, TX |
| 1285115709 | Kathleen Gainous | Individual | Occupational Therapy Assistant | Waco, TX |
Verify this record
Cross-check NPI 1720086655 against the authoritative CMS record: view Providence Park, Inc. on the official NPPES registry .
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 or validate an NPI number.
Frequently asked questions
What type of organization is Providence Park, Inc.?
What is a Type 2 NPI?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2025-06-23.