Provider Demographics
NPI:1194725952
Name:TELESIS/SIGNATURE PLACE I, LTD.
Entity type:Organization
Organization Name:TELESIS/SIGNATURE PLACE 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 1:14655 PRESTON RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7805
Mailing Address - Country:US
Mailing Address - Phone:972-726-7575
Mailing Address - Fax:972-726-9742
Practice Address - Street 1:14655 PRESTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7805
Practice Address - Country:US
Practice Address - Phone:972-726-7575
Practice Address - Fax:972-726-9742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00293314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675757Medicare ID - Type UnspecifiedMCR PROVIDER NUMBER