Healthcare Provider Details

I. General information

NPI: 1194725952
Provider Name (Legal Business Name): TELESIS/SIGNATURE PLACE I, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14655 PRESTON RD
DALLAS TX
75254-7805
US

IV. Provider business mailing address

14655 PRESTON RD
DALLAS TX
75254-7805
US

V. Phone/Fax

Practice location:
  • Phone: 972-726-7575
  • Fax: 972-726-9742
Mailing address:
  • Phone: 972-726-7575
  • Fax: 972-726-9742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number00293
License Number StateTX

VIII. Authorized Official

Name: MS. BETTY Y. JANKO
Title or Position: SECRETARY
Credential:
Phone: 214-826-6870