Healthcare Provider Details

I. General information

NPI: 1477863660
Provider Name (Legal Business Name): LEGEND OAKS - KYLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 03/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 FAIRWAY
KYLE TX
78640-9998
US

IV. Provider business mailing address

1390 E BITTERS RD
SAN ANTONIO TX
78216-2914
US

V. Phone/Fax

Practice location:
  • Phone: 512-268-1003
  • Fax:
Mailing address:
  • Phone: 210-564-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

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