Organization
LTC OF FALL CREEK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARLYN THREADGILL (PRESIDENT)
(512) 482-8242
Entity
Organization
Contact information
Practice address
14949 MESA DR, HUMBLE, TX 77396-2952
(281) 902-4152
Mailing address
200 CONGRESS AVE, SUITE 30A, AUSTIN, TX 78701-4527
(512) 482-8242
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001027972
—
TX
Enumeration date
07/06/2016
Last updated
12/17/2017
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