Provider Demographics
NPI:1508176520
Name:LTC OF AUSTIN COUNTY I, LLC
Entity Type:Organization
Organization Name:LTC OF AUSTIN COUNTY I, LLC
Other - Org Name:COLONIAL BELLE NURSING HOME SEALY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CELINA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHARIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-651-3694
Mailing Address - Street 1:1401 EAGLE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:SEALY
Mailing Address - State:TX
Mailing Address - Zip Code:77474-3109
Mailing Address - Country:US
Mailing Address - Phone:979-865-2937
Mailing Address - Fax:979-865-0780
Practice Address - Street 1:1401 EAGLE LAKE RD
Practice Address - Street 2:
Practice Address - City:SEALY
Practice Address - State:TX
Practice Address - Zip Code:77474-3109
Practice Address - Country:US
Practice Address - Phone:979-865-2937
Practice Address - Fax:979-865-0780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100852313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100852OtherFACILITY LICENSE
TX5424Medicaid