MEDICARE: LANCASTER LTC PARTNERS, 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
1	314000000X	Skilled Nursing Facility	5115	TX

General Provider Information

NPI Number	:	1164929832
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANCASTER LTC PARTNERS, INC.

Provider Business Mailing Address
First Line	:	1515 N ELM ST
Second Line	:
City	:	LANCASTER
State	:	TX
Zip	:	75134-3241
Country	:	US
Telephone Number	:	979-227-6066
Fax Number	:	866-354-8161

Provider Business Practice Location Address
First Line	:	1515 N ELM ST
Second Line	:
City	:	LANCASTER
State	:	TX
Zip	:	75134-3241
Country	:	US
Telephone Number	:	979-227-6066
Fax Number	:	866-354-8161

Authorized Official
Title or Position	:	CEO
Name	:	LOUIS FREDERICK NICHOLSON III
Credential	:
Telephone Number	:	832-489-9944

Provider Enumeration Date	:	04/10/2018
Last Update Date	:	04/10/2018

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