NPIMap

Organization Active NPI

St. Giles Living Centers, Inc.

  • Intellectual Disabilities Intermediate Care Facility
  • Tyler, TX
National Provider Identifier
1104427509
Registry record updated Nov 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
ST. GILES LIVING CENTERS, INC.
Practice address
2812 Shaffer LN
Tyler, TX 75702-1653
Phone
(800) 299-5161
Fax
(817) 447-3033
NPI assigned
Nov 3, 2020
Organization subpart
Yes
Parent organization
ST. GILES LIVING CENTERS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 3, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Anna Todd
Title
Operations Business Manager
Phone
(800) 299-5161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

2812 Shaffer LN
Tyler, TX 75702-1653

Mailing address

4800 Overton PLZ Ste 440
Fort Worth, TX 76109-4435
Phone (800) 299-5161

Other names 1

  • 2812 Shaffer Lane Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Intermediate care facility for individuals with intellectual disabilities certification: CCN 45H037

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
2812 SHAFFER LANE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Jan 8, 1993
Last certification
Sep 26, 2024
Beds
6
Ownership / control type
Private (proprietary)
Facility address
2812 Shaffer Lane
Tyler, TX 75702

National Provider Directory

National Provider Directory
Tax ID family
St Giles Living Centers Inc9 organizations share this tax ID, including this one
Part of
St Giles Living Centers Inc

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604361600000",
    "number": "1104427509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 OVERTON PLZ STE 440",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094435",
            "telephone_number": "800-299-5161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2812 SHAFFER LN",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757021653",
            "telephone_number": "800-299-5161",
            "fax_number": "817-447-3033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. GILES LIVING CENTERS, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. GILES LIVING CENTERS, INC.",
        "enumeration_date": "2020-11-03",
        "last_updated": "2020-11-03",
        "certification_date": "2020-11-03",
        "status": "A",
        "authorized_official_last_name": "TODD",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "OPERATIONS BUSINESS MANAGER",
        "authorized_official_telephone_number": "800-299-5161"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "2812 Shaffer Lane",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.