# LEGEND OAKS - GRANITE MESA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Granite Mesa Health Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750719068
- **Authorized official:** THOMAS MARTIN TOMERLIN (PRESIDENT/COO/MANAGER)
- **Authorized official phone:** (210) 564-0100

## Contact information

- **Practice address:** 1401 MAX COPELAND DR, MARBLE FALLS, TX 78654-4665
- **Practice address phone:** (830) 693-0022
- **Mailing address:** 1390 E BITTERS RD, SAN ANTONIO, TX 78216-2914

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 10/23/2013
- **Last updated:** 03/25/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001025552 | — | TX |