Provider Demographics
NPI:1205017472
Name:CAMBRIDGE LTC PARTNERS, INC.
Entity Type:Organization
Organization Name:CAMBRIDGE LTC PARTNERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:III
Authorized Official - Credentials:LNFA
Authorized Official - Phone:832-489-9944
Mailing Address - Street 1:1621 BUTLER DR
Mailing Address - Street 2:
Mailing Address - City:DIMMITT
Mailing Address - State:TX
Mailing Address - Zip Code:79027-2701
Mailing Address - Country:US
Mailing Address - Phone:806-647-3117
Mailing Address - Fax:806-647-5212
Practice Address - Street 1:1621 BUTLER DR
Practice Address - Street 2:
Practice Address - City:DIMMITT
Practice Address - State:TX
Practice Address - Zip Code:79027-2701
Practice Address - Country:US
Practice Address - Phone:806-647-3117
Practice Address - Fax:806-647-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-16
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122924314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004948Medicaid
TX001015400Medicaid
TX676186Medicare PIN