Healthcare Provider Details

I. General information

NPI: 1205017472
Provider Name (Legal Business Name): CAMBRIDGE LTC PARTNERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 BUTLER DR
DIMMITT TX
79027-2701
US

IV. Provider business mailing address

1621 BUTLER DR
DIMMITT TX
79027-2701
US

V. Phone/Fax

Practice location:
  • Phone: 806-647-3117
  • Fax: 806-647-5212
Mailing address:
  • Phone: 806-647-3117
  • Fax: 806-647-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number122924
License Number StateTX

VIII. Authorized Official

Name: MR. LOUIS FREDERICK NICHOLSON III
Title or Position: PRESIDENT
Credential: LNFA
Phone: 832-489-9944