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Organization
LEGEND HEALTHCARE JACKSONVILLE, LLC
Active
Organization
LEGEND HEALTHCARE JACKSONVILLE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN TOMERLIN (PRESIDENT)
(210) 564-0100
Entity
Organization
Contact information
Practice address
810 BELAIRE ST, JACKSONVILLE, TX 75766-9045
(903) 589-5300
(903) 589-5335
Mailing address
608 SANDAU RD, SAN ANTONIO, TX 78216-4131
(210) 564-0100
(210) 564-0157
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
5478
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001014058
—
TX
Enumeration date
10/05/2006
Last updated
04/01/2009
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