Provider Demographics
NPI:1053311886
Name:TELESIS- WALNUT PLACE NURSING HOME I LTD.
Entity Type:Organization
Organization Name:TELESIS- WALNUT PLACE NURSING HOME I LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:JANKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-826-6870
Mailing Address - Street 1:5515 GLEN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4309
Mailing Address - Country:US
Mailing Address - Phone:214-361-8923
Mailing Address - Fax:214-361-4782
Practice Address - Street 1:5515 GLEN LAKES DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4309
Practice Address - Country:US
Practice Address - Phone:214-361-8923
Practice Address - Fax:214-361-4782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000115314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675765Medicare Oscar/Certification
TX0498510001Medicare NSC