Provider Demographics
NPI:1922008838
Name:TELESIS-AUTUMN LEAVES I, LTD
Entity Type:Organization
Organization Name:TELESIS-AUTUMN LEAVES 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 1:1010 EMERALD ISLE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3980
Mailing Address - Country:US
Mailing Address - Phone:214-328-4161
Mailing Address - Fax:214-319-9184
Practice Address - Street 1:1010 EMERALD ISLE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3980
Practice Address - Country:US
Practice Address - Phone:214-328-4161
Practice Address - Fax:214-319-9184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000108314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility