# LTC HEALTHCARE SHEPARD INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Woodland Park
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306879580
- **Authorized official:** MR. DOUGLAS K MITTLEIDER (PRESIDENT)
- **Authorized official phone:** (770) 870-2813

## Contact information

- **Practice address:** 101 WOODLAND PARK DR, SHEPHERD, TX 77371-6497
- **Practice address phone:** (936) 628-3388
- **Practice address fax:** (936) 628-6387
- **Mailing address:** 5895 WINDWARD PARKWAY, SUITE 200, ALPHARETTA, GA 30005-8805
- **Mailing address phone:** (770) 870-2813
- **Mailing address fax:** (770) 870-2892

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 115618 | TX | Yes |

## Other

- **Enumeration date:** 07/09/2006
- **Last updated:** 05/12/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001001399 | — | TX |