Provider Demographics
NPI:1295032464
Name:TENAHA CREEK LLC
Entity Type:Organization
Organization Name:TENAHA CREEK LLC
Other - Org Name:LAKESIDE VILLAGE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINTIGNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-590-9300
Mailing Address - Street 1:1468 LOOP 500
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935
Mailing Address - Country:US
Mailing Address - Phone:936-590-9300
Mailing Address - Fax:936-590-9315
Practice Address - Street 1:1468 LOOP 500
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935
Practice Address - Country:US
Practice Address - Phone:936-590-9300
Practice Address - Fax:936-590-9315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131183310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility