=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295032464
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TENAHA CREEK LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2011
-----------------------------------------------------
Last Update Date | 02/23/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1468 LOOP 500
-----------------------------------------------------
City | CENTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-590-9300
-----------------------------------------------------
Fax | 936-590-9315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1468 LOOP 500
-----------------------------------------------------
City | CENTER
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 936-590-9300
-----------------------------------------------------
Fax | 936-590-9315
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/OWNER
-----------------------------------------------------
Name | MR. MARK SAINTIGNAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 936-590-9300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 131183
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------