Basic Information
Provider Information
NPI: 1326490541
EntityType: 2
ReplacementNPI:  
OrganizationName: SHEPHERD LTC PARTNERS, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 101 WOODLAND PARK DR
Address2:  
City: SHEPHERD
State: TX
PostalCode: 773716497
CountryCode: US
TelephoneNumber: 9366283388
FaxNumber: 9366286387
Practice Location
Address1: 101 WOODLAND PARK DR
Address2:  
City: SHEPHERD
State: TX
PostalCode: 773716497
CountryCode: US
TelephoneNumber: 9366283388
FaxNumber: 9366286387
Other Information
ProviderEnumerationDate: 07/12/2016
LastUpdateDate: 01/20/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: NICHOLSON
AuthorizedOfficialFirstName: LOUIS
AuthorizedOfficialMiddleName: FREDERICK
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 8324899944
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix: III
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X001028068TXN Nursing & Custodial Care FacilitiesSkilled Nursing Facility 
314000000X675484TXN Nursing & Custodial Care FacilitiesSkilled Nursing Facility 
314000000X005350TXY Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

ID Information
IDTypeStateIssuerDescription
00102806805TX MEDICAID
00535001TXFACILITY IDOTHER


Home