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NPI Code Detail

MEDICARE: LTC HEALTHCARE OF CONVERSE, INC.

MEDICARE: LTC HEALTHCARE OF CONVERSE, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility115216TX

General Provider Information

NPI Number : 1083647069
Entity Type Code : Organization
Provider Name (Legal Business Name) : LTC HEALTHCARE OF CONVERSE, INC.
Provider Business Mailing Address
First Line : 925 N POINT PKWY
Second Line : SUITE 440
City : ALPHARETTA
State : GA
Zip : 30005-5210
Country : US
Telephone Number : 770-619-0866
Fax Number : 770-870-2892
Provider Business Practice Location Address
First Line : 7700 MESQUITE PASS
Second Line :
City : CONVERSE
State : TX
Zip : 78109-2461
Country : US
Telephone Number : 210-650-0551
Fax Number : 210-650-4472
Authorized Official
Title or Position : PRIVACY OFFICER
Name : MS. LOUANN ANSTIS
Credential :
Telephone Number : 770-619-0866
Provider Enumeration Date : 07/10/2006
Last Update Date : 08/22/2020

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