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General NPI Number Information
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NPI Number | 1336185289
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Entity Type | Organization
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Legal Business Name | LTC MANAGEMENT SERVICES LLC
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14800 SAINT MARYS LN SUITE 175
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City | HOUSTON
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State | TX
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Zip | 77079-2935
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Country | US
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Telephone | 832-448-3705
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Fax | 832-448-3706
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Provider Business Mailing Address
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Address Line | 14800 SAINT MARYS LN SUITE 175
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City | HOUSTON
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State | TX
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Zip | 77079-2935
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Country | US
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Telephone | 832-448-3705
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Fax | 832-448-3706
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAKE HALLSTED
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Credential |
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Telephone | 832-448-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 0083336
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License Number State | TX
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