Provider Demographics
NPI:1790979623
Name:LEGEND HEALTHCARE MIDLAND, LLC
Entity Type:Organization
Organization Name:LEGEND HEALTHCARE MIDLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-564-0100
Mailing Address - Street 1:608 SANDAU
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4131
Mailing Address - Country:US
Mailing Address - Phone:210-564-0100
Mailing Address - Fax:210-564-0157
Practice Address - Street 1:3000 MOCKINGBIRD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-1608
Practice Address - Country:US
Practice Address - Phone:432-694-0077
Practice Address - Fax:432-694-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility