LTC Healthcare Shepard Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

115618 Issued in TX

Legal business name

LTC HEALTHCARE SHEPARD INC

Doing business as

Woodland Park

Practice address

101 Woodland Park Dr
Shepherd, TX 77371-6497

Phone

(936) 628-3388

Fax

(936) 628-6387

NPI assigned

Jul 9, 2006

Last updated

May 12, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Douglas K Mittleider

Title

President

Phone

(770) 870-2813

Specialties & licenses 1

Addresses

Other names 1

• Woodland Park Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431388800000",
    "number": "1306879580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5895 WINDWARD PARKWAY",
            "address_2": "SUITE 200",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300058805",
            "telephone_number": "770-870-2813",
            "fax_number": "770-870-2892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 WOODLAND PARK DR",
            "city": "SHEPHERD",
            "state": "TX",
            "postal_code": "773716497",
            "telephone_number": "936-628-3388",
            "fax_number": "936-628-6387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LTC HEALTHCARE SHEPARD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2015-05-12",
        "status": "A",
        "authorized_official_last_name": "MITTLEIDER",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-870-2813",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "115618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Woodland Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lauren Michel Estridge, MS, ATC, LAT
• Goodrich Isd
• Eric Demond Green
• Health Center of Southeast Texas (Health Center of Southeast Texas - Shepherd)
• Nanci Loren
• David W. Middlebush
• Stephanie Gail Myers-Kiker
• Laurier Junior Paul, NP
• PNV Creative Care, Inc (Shepherd Pharmacy)
• PNV Creative Care, Inc (Shepherd Pharmacy)

• Skilled Nursing Facility in Shepherd, TX
• Providers in Shepherd, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.