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General NPI Number Information
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NPI Number | 1497788269
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Entity Type | Organization
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Legal Business Name | GROESBECK LTC PARTNERS, INC.
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 607 PARKSIDE DR
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City | GROESBECK
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State | TX
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Zip | 76642-1124
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Country | US
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Telephone | 254-729-3245
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Fax | 254-729-3788
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Provider Business Mailing Address
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Address Line | 607 PARKSIDE DR
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City | GROESBECK
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State | TX
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Zip | 76642-1124
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Country | US
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Telephone | 254-729-3245
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Fax | 254-729-3788
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Authorized Official
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Title or Position | CEO
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Name | MR. LOUIS FREDERICK NICHOLSON III
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Credential | LNFA
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Telephone | 832-489-9944
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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 | 124523
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License Number State | TX
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