Organization
PARK PLAZA LTC PARTNERS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LOUIS FREDERICK NICHOLSON III LNFA (PRESIDENT)
(832) 489-9944
Entity
Organization
Contact information
Practice address
2210 HOWARD ST, SAN ANGELO, TX 76901-1318
(325) 944-0561
(325) 944-0562
Mailing address
2210 HOWARD ST, SAN ANGELO, TX 76901-1318
(325) 944-0561
(325) 944-0562
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004561
FACILITY ID
TX
Enumeration date
04/27/2009
Last updated
01/14/2015
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