Basic Information
| Provider Information | |||||||||
| NPI: | 1952575482 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TTCM 1 LP | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | HICO CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX G | ||||||||
| Address2: | |||||||||
| City: | HICO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764570200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547962111 | ||||||||
| FaxNumber: | 2547962327 | ||||||||
| Practice Location | |||||||||
| Address1: | 712 RAILRAOD ST | ||||||||
| Address2: | PO DRAWER G | ||||||||
| City: | HICO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764570200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547962111 | ||||||||
| FaxNumber: | 2547962327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2008 | ||||||||
| LastUpdateDate: | 04/16/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LANE | ||||||||
| AuthorizedOfficialFirstName: | CYDNIE | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | LIMITED PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2547962111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.