Organization
LEGEND OAKS - GRANITE MESA, LLC
Active
Other names
Granite Mesa Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS MARTIN TOMERLIN (PRESIDENT/COO/MANAGER)
(210) 564-0100
Entity
Organization
Contact information
Practice address
1401 MAX COPELAND DR, MARBLE FALLS, TX 78654-4665
(830) 693-0022
Mailing address
1390 E BITTERS RD, SAN ANTONIO, TX 78216-2914
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001025552
—
TX
Enumeration date
10/23/2013
Last updated
03/25/2015
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