MEDICARE: ST. GILES LIVING CENTERS, INC.

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	001007212	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194893180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. GILES LIVING CENTERS, INC.

Provider Business Mailing Address
First Line	:	4150 INTERNATIONAL PLZ STE 820
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4836
Country	:	US
Telephone Number	:	800-299-5161
Fax Number	:	817-447-3033

Provider Business Practice Location Address
First Line	:	4150 INTERNATIONAL PLZ STE 820
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4836
Country	:	US
Telephone Number	:	800-299-5161
Fax Number	:	817-447-3033

Authorized Official
Title or Position	:	LICENSING COORDINATOR
Name	:	BRANDI TURNER
Credential	:
Telephone Number	:	682-707-2756

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	05/13/2025

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