Provider Demographics
NPI:1437337425
Name:KATY LTC HOLDINGS GROUP LTD
Entity Type:Organization
Organization Name:KATY LTC HOLDINGS GROUP LTD
Other - Org Name:THE GRACE CARE CENTER OF KATY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LIMITED PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLSTED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-448-3700
Mailing Address - Street 1:23553 WEST FERNHURST DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-0686
Mailing Address - Country:US
Mailing Address - Phone:281-394-1300
Mailing Address - Fax:281-394-1301
Practice Address - Street 1:23553 WEST FERNHURST DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-0686
Practice Address - Country:US
Practice Address - Phone:281-394-1300
Practice Address - Fax:281-394-1301
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SNF PARTNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-01
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103448314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001016103Medicaid
TX208353701OtherMEDICAID TPI
TX001016103Medicaid