Organization
LTC HEALTHCARE SHEPARD INC
Active
Other names
Woodland Park
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DOUGLAS K MITTLEIDER (PRESIDENT)
(770) 870-2813
Entity
Organization
Contact information
Practice address
101 WOODLAND PARK DR, SHEPHERD, TX 77371-6497
(936) 628-3388
(936) 628-6387
Mailing address
5895 WINDWARD PARKWAY, SUITE 200, ALPHARETTA, GA 30005-8805
(770) 870-2813
(770) 870-2892
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
115618
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001001399
—
TX
Enumeration date
07/09/2006
Last updated
05/12/2015
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