Provider Demographics
NPI:1750558607
Name:LTC INFORMATION SYSTEMS, INC
Entity type:Organization
Organization Name:LTC INFORMATION SYSTEMS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:V. PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-445-2517
Mailing Address - Street 1:118 E LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76446-1914
Mailing Address - Country:US
Mailing Address - Phone:254-445-2517
Mailing Address - Fax:254-445-3960
Practice Address - Street 1:616 E TRUETT ST
Practice Address - Street 2:
Practice Address - City:WINTERS
Practice Address - State:TX
Practice Address - Zip Code:79567-4527
Practice Address - Country:US
Practice Address - Phone:325-754-5083
Practice Address - Fax:325-754-4570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001016273Medicaid
TX001016272Medicaid