Provider Demographics
NPI:1588664320
Name:TELESIS-TRAYMORE NURSING HOME I, LTD.
Entity Type:Organization
Organization Name:TELESIS-TRAYMORE NURSING HOME I, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-826-6870
Mailing Address - Street 1:4315 HOPKINS AVE.
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-3026
Mailing Address - Country:US
Mailing Address - Phone:214-358-3131
Mailing Address - Fax:214-358-0846
Practice Address - Street 1:4315 HOPKINS AVE.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-3026
Practice Address - Country:US
Practice Address - Phone:214-358-3131
Practice Address - Fax:214-358-0846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000113314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675754Medicare ID - Type UnspecifiedMCR PROVIDER NUMBER