Healthcare Provider Details

I. General information

NPI: 1497856413
Provider Name (Legal Business Name): LEGEND HEALTHCARE EULESS, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WESTPARK WAY
EULESS TX
76040-3977
US

IV. Provider business mailing address

1390 E BITTERS RD
SAN ANTONIO TX
78216-2914
US

V. Phone/Fax

Practice location:
  • Phone: 817-545-4071
  • Fax: 817-684-8341
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 Number5041
License Number StateTX

VIII. Authorized Official

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