Provider Demographics
NPI:1972503720
Name:TELESIS-PARKWOOD CARE I, LTD.
Entity Type:Organization
Organization Name:TELESIS-PARKWOOD CARE 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 1:2600 PARKVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-7989
Mailing Address - Country:US
Mailing Address - Phone:817-267-7373
Mailing Address - Fax:817-354-1808
Practice Address - Street 1:2600 PARKVIEW LN
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-7989
Practice Address - Country:US
Practice Address - Phone:817-267-7373
Practice Address - Fax:817-354-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000268314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675565Medicare Oscar/Certification
TX1074520001Medicare NSC