Healthcare Provider Details

I. General information

NPI: 1982705927
Provider Name (Legal Business Name): LEGEND HEALTHCARE DRIPPING SPRINGS, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 W HIGHWAY 290
DRIPPING SPRINGS TX
78620-3402
US

IV. Provider business mailing address

608 SANDAU RD
SAN ANTONIO TX
78216-4131
US

V. Phone/Fax

Practice location:
  • Phone: 512-858-5624
  • Fax: 512-858-1638
Mailing address:
  • Phone: 210-564-0100
  • Fax: 210-564-0157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number5205
License Number StateTX

VIII. Authorized Official

Name: MARTIN TOMERLIN
Title or Position: PRESIDENT
Credential:
Phone: 210-564-0100