Provider Demographics
NPI:1801393665
Name:DESOTO LTC PARTNERS, INC.
Entity Type:Organization
Organization Name:DESOTO LTC PARTNERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:832-489-9944
Mailing Address - Street 1:1101 N HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-3951
Mailing Address - Country:US
Mailing Address - Phone:979-223-3944
Mailing Address - Fax:866-354-8161
Practice Address - Street 1:1101 N HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-3951
Practice Address - Country:US
Practice Address - Phone:979-223-3944
Practice Address - Fax:866-354-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5116314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility