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NPI Code Detail

MEDICARE: TELESIS-AUTUMN LEAVES I, LTD

MEDICARE: TELESIS-AUTUMN LEAVES 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
1314000000XSkilled Nursing Facility000108TX

General Provider Information

NPI Number : 1922008838
Entity Type Code : Organization
Provider Name (Legal Business Name) : TELESIS-AUTUMN LEAVES I, LTD
Provider Business Mailing Address
First Line : 1010 EMERALD ISLE DR
Second Line :
City : DALLAS
State : TX
Zip : 75218-3980
Country : US
Telephone Number : 214-328-4161
Fax Number : 214-319-9184
Provider Business Practice Location Address
First Line : 1010 EMERALD ISLE DR
Second Line :
City : DALLAS
State : TX
Zip : 75218-3980
Country : US
Telephone Number : 214-328-4161
Fax Number : 214-319-9184
Authorized Official
Title or Position : SECRETARY
Name : MS. BETTY Y. JANKO
Credential :
Telephone Number : 214-826-6870
Provider Enumeration Date : 07/21/2005
Last Update Date : 05/20/2010

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