Provider Demographics
NPI:1598861130
Name:ACTIVCARE AT TURTLE CREEK LP
Entity Type:Organization
Organization Name:ACTIVCARE AT TURTLE CREEK LP
Other - Org Name:ASHLEY COURT AT TURTLE CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-565-4424
Mailing Address - Street 1:9619 CHESAPEAKE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1368
Mailing Address - Country:US
Mailing Address - Phone:858-565-4424
Mailing Address - Fax:858-565-2428
Practice Address - Street 1:3611 DICKASON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4912
Practice Address - Country:US
Practice Address - Phone:858-565-4424
Practice Address - Fax:858-565-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112061314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
675895Medicare ID - Type Unspecified