NPIMap

Organization Active NPI

St. Giles Living Centers, Inc.

Doing business as 2525 Preston Avenue

  • Intellectual Disabilities Intermediate Care Facility
  • Tyler, TX
National Provider Identifier
1568063527
Registry record updated Nov 5, 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.
Doing business as
2525 Preston Avenue
Practice address
2525 Preston Ave
Tyler, TX 75701-4644
Phone
(800) 299-5161
Fax
(817) 447-3033
NPI assigned
Nov 5, 2020
Last updated
Nov 5, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. GILES LIVING CENTERS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 5, 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

2525 Preston Ave
Tyler, TX 75701-4644

Mailing address

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

Other names 1

  • 2525 Preston Avenue Doing business as

Medicare participation

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568063527. Details of each certification follow.

  • CCN 45G872 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 45G872

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
2525 PRESTON AVENUE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Dec 17, 1991
Last certification
Aug 15, 2024
Beds
6
Ownership / control type
Private (proprietary)
Facility address
2525 Preston Avenue
Tyler, TX 75701

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.

Locations

4800 Overton Plz
Ste 440
Ft Worth, TX 76109
Phone (903) 658-2705

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": "1604534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604534400000",
    "number": "1568063527",
    "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": "2525 PRESTON AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757014644",
            "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": "2020-11-05",
        "last_updated": "2020-11-05",
        "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": "2525 Preston Avenue",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.