Healthcare Provider Details

I. General information

NPI: 1952575482
Provider Name (Legal Business Name): TTCM 1 LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 RAILRAOD ST PO DRAWER G
HICO TX
76457-0200
US

IV. Provider business mailing address

PO BOX G
HICO TX
76457-0200
US

V. Phone/Fax

Practice location:
  • Phone: 254-796-2111
  • Fax: 254-796-2327
Mailing address:
  • Phone: 254-796-2111
  • Fax: 254-796-2327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. CYDNIE G LANE
Title or Position: LIMITED PARTNER
Credential:
Phone: 254-796-2111