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NPI Code Detail

MEDICARE: TELESIS-WALNUT PLACE NURSING HOME I LTD

MEDICARE: TELESIS-WALNUT PLACE NURSING HOME I LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy
23336L0003XLong Term Care Pharmacy11588TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14571938OTHEROTHER ID NUMBER

General Provider Information

NPI Number : 1043315229
Entity Type Code : Organization
Provider Name (Legal Business Name) : TELESIS-WALNUT PLACE NURSING HOME I LTD
Provider Business Mailing Address
First Line : 5515 GLEN LAKES DR
Second Line :
City : DALLAS
State : TX
Zip : 75231-4309
Country : US
Telephone Number : 214-361-8923
Fax Number : 214-361-4281
Provider Business Practice Location Address
First Line : 5515 GLEN LAKES DR
Second Line :
City : DALLAS
State : TX
Zip : 75231-4309
Country : US
Telephone Number : 214-361-8923
Fax Number : 214-361-4281
Authorized Official
Title or Position : PHARMACIST AND MANAGER
Name : MR. ROLIN SAMUEL GREEN JR.
Credential :
Telephone Number : 214-361-8923
Provider Enumeration Date : 09/13/2006
Last Update Date : 10/08/2008

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Directions to “TELESIS-WALNUT PLACE NURSING HOME I LTD ” Practice Location

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