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NPI Code Detail

MEDICARE: SOUTHWEST LTC GULF HEALTHCARE LTD

MEDICARE: SOUTHWEST LTC GULF HEALTHCARE LTD
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 Facility005325TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285628370
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHWEST LTC GULF HEALTHCARE LTD
Provider Business Mailing Address
First Line : 1518 LEGACY DR
Second Line : SUITE 110
City : FRISCO
State : TX
Zip : 75034-6038
Country : US
Telephone Number : 469-916-6100
Fax Number : 469-916-6105
Provider Business Practice Location Address
First Line : 1720 N LOGAN ST
Second Line :
City : TEXAS CITY
State : TX
Zip : 77590-4931
Country : US
Telephone Number : 469-916-6100
Fax Number : 469-916-6105
Authorized Official
Title or Position : CEO
Name : RONALD R PAYNE
Credential : ESQ.
Telephone Number : 469-916-6100
Provider Enumeration Date : 09/06/2005
Last Update Date : 06/02/2015

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Directions to “SOUTHWEST LTC GULF HEALTHCARE LTD ” Practice Location

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