Provider Demographics
NPI:1780002535
Name:TEAGUE LTC PARTNERS, INC.
Entity Type:Organization
Organization Name:TEAGUE LTC PARTNERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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 1:8505 TECHNOLOGY FOREST PL
Mailing Address - Street 2:SUITE 1004
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1000
Mailing Address - Country:US
Mailing Address - Phone:281-414-5744
Mailing Address - Fax:866-354-8161
Practice Address - Street 1:884 US HIGHWAY 84 W
Practice Address - Street 2:
Practice Address - City:TEAGUE
Practice Address - State:TX
Practice Address - Zip Code:75860-5142
Practice Address - Country:US
Practice Address - Phone:254-739-2541
Practice Address - Fax:254-739-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-30
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX005013314000000X
TX001025830314000000X
TX675884314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001025830Medicaid
TX5013Medicaid