Provider Demographics
NPI:1972785020
Name:SOUTHWEST LTC LAMAR LTD
Entity Type:Organization
Organization Name:SOUTHWEST LTC LAMAR LTD
Other - Org Name:DEPORT NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-916-6100
Mailing Address - Street 1:17760 PRESTON RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5663
Mailing Address - Country:US
Mailing Address - Phone:469-916-6100
Mailing Address - Fax:469-916-6105
Practice Address - Street 1:126 US HIGHWAY 271 SOUTH
Practice Address - Street 2:
Practice Address - City:DEPORT
Practice Address - State:TX
Practice Address - Zip Code:75435-2534
Practice Address - Country:US
Practice Address - Phone:903-652-4410
Practice Address - Fax:903-652-4618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAPPLIED314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility