MEDICARE: THI OF TEXAS AT FOREST LANE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053408237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THI OF TEXAS AT FOREST LANE, LLC

Provider Business Mailing Address
First Line	:	920 RIDGEBROOK RD
Second Line	:
City	:	SPARKS
State	:	MD
Zip	:	21152-9390
Country	:	US
Telephone Number	:	410-773-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	9009 FOREST LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-4114
Country	:	US
Telephone Number	:	972-783-1771
Fax Number	:	972-783-1774

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RODRIGO GIACINTI
Credential	:
Telephone Number	:	972-783-1771

Provider Enumeration Date	:	10/07/2006
Last Update Date	:	08/18/2011

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Directions to “THI OF TEXAS AT FOREST LANE, LLC ” Practice Location

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