Provider Demographics
NPI:1386954469
Name:LTC OF AUSTIN COUNTY III, LLC
Entity type:Organization
Organization Name:LTC OF AUSTIN COUNTY III, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:1517 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77418-9737
Mailing Address - Country:US
Mailing Address - Phone:979-865-3969
Mailing Address - Fax:979-865-2381
Practice Address - Street 1:1517 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLVILLE
Practice Address - State:TX
Practice Address - Zip Code:77418-9737
Practice Address - Country:US
Practice Address - Phone:979-865-3969
Practice Address - Fax:979-865-2381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102574310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility