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General NPI Number Information
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NPI Number | 1083647069
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Entity Type | Organization
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Legal Business Name | LTC HEALTHCARE OF CONVERSE, INC.
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7700 MESQUITE PASS
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City | CONVERSE
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State | TX
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Zip | 78109-2461
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Country | US
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Telephone | 210-650-0551
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Fax | 210-650-4472
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Provider Business Mailing Address
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Address Line | 925 N POINT PKWY SUITE 440
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City | ALPHARETTA
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State | GA
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Zip | 30005-5210
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Country | US
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Telephone | 770-619-0866
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Fax | 770-870-2892
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Authorized Official
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Title or Position | PRIVACY OFFICER
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Name | MS. LOUANN ANSTIS
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Credential |
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Telephone | 770-619-0866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 115216
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License Number State | TX
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