LTC of Austin County I, LLC

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

100852 Issued in TX

Legal business name

LTC OF AUSTIN COUNTY I, LLC

Doing business as

Colonial Belle Nursing Home Sealy

Practice address

1401 Eagle Lake Rd
Sealy, TX 77474-3109

Phone

(979) 865-2937

Fax

(979) 865-0780

NPI assigned

Oct 8, 2010

Organization subpart

No

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

Authorized official

Name

Celina C Shariff

Title

Manager

Phone

(832) 651-3694

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Colonial Belle Nursing Home Sealy Doing business as

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

{
    "created_epoch": "1286496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319673600000",
    "number": "1508176520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 EAGLE LAKE RD",
            "city": "SEALY",
            "state": "TX",
            "postal_code": "774743109",
            "telephone_number": "979-865-2937",
            "fax_number": "979-865-0780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 EAGLE LAKE RD",
            "city": "SEALY",
            "state": "TX",
            "postal_code": "774743109",
            "telephone_number": "979-865-2937",
            "fax_number": "979-865-0780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LTC OF AUSTIN COUNTY I, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-08",
        "last_updated": "2011-10-27",
        "status": "A",
        "authorized_official_last_name": "SHARIFF",
        "authorized_official_first_name": "CELINA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "832-651-3694"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "TX",
            "license": "100852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FACILITY LICENSE",
            "identifier": "100852",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5424",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Colonial Belle Nursing Home Sealy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kannappan Krishnaswamy, M.D.
• Rosemary Mwale Kungu, FNP-BC
• Lifechek Huntsville LLC
• Regina Lisiecki, LPC
• James Wayne Lowman, D.C.
• M.T.Garcia D.D.S
• Marcy McNeely, PHARM.D.
• Melaney Davis- McShan, LPC
• Judi D. McTigue, PTA
• Susan Mercer, OTR

• Nursing Facility/Intermediate Care Facility in Sealy, TX
• Providers in Sealy, TX by specialty
• Nursing Facility/Intermediate Care Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.