MEDICARE: MEXIA LTC PARTNERS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	004868	OTHER	TX	FACILITY IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1629395850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEXIA LTC PARTNERS, INC.

Provider Business Mailing Address
First Line	:	601 TERRACE LN
Second Line	:
City	:	MEXIA
State	:	TX
Zip	:	76667-2072
Country	:	US
Telephone Number	:	254-562-5400
Fax Number	:	254-562-9145

Provider Business Practice Location Address
First Line	:	601 TERRACE LN
Second Line	:
City	:	MEXIA
State	:	TX
Zip	:	76667-2072
Country	:	US
Telephone Number	:	254-562-5400
Fax Number	:	254-562-9145

Authorized Official
Title or Position	:	CEO
Name	:	MR. LOUIS FREDERICK NICHOLSON III
Credential	:	LNFA
Telephone Number	:	832-489-9944

Provider Enumeration Date	:	04/28/2010
Last Update Date	:	01/14/2015

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Directions to “MEXIA LTC PARTNERS, INC. ” Practice Location

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