Provider Demographics
NPI:1407023518
Name:WEST TEXAS LTC PARTNERS, INC.
Entity Type:Organization
Organization Name:WEST TEXAS 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 1:1915 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-1112
Mailing Address - Country:US
Mailing Address - Phone:325-942-0677
Mailing Address - Fax:325-942-1331
Practice Address - Street 1:1915 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-1112
Practice Address - Country:US
Practice Address - Phone:325-942-0677
Practice Address - Fax:325-942-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124667314000000X
TX001016152314000000X
TX676068314000000X
TX5236314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5236Medicaid
TX001016152Medicaid
TX676068Medicare PIN