Healthcare Provider Details

I. General information

NPI: 1609334259
Provider Name (Legal Business Name): LS LAMPASAS OPERATOR II, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2019
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E AVE J
LAMPASAS TX
76550-1211
US

IV. Provider business mailing address

1000 E AVENUE J
LAMPASAS TX
76550-1211
US

V. Phone/Fax

Practice location:
  • Phone: 512-556-6267
  • Fax: 512-556-6601
Mailing address:
  • Phone: 512-556-6267
  • Fax: 512-556-4428

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: JACOB WINTNER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 323-651-1808