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Organization
GARDENDALE HH OPCO LLC
Active
Organization
GARDENDALE HH OPCO LLC
Active
Other names
Gardendale Healthcare Residence
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL LITTLE (MANAGER)
(888) 396-3462
Entity
Organization
Contact information
Practice address
1521 E RUSK ST, JACKSONVILLE, TX 75766-5505
(903) 586-3626
(903) 586-2766
Mailing address
1521 E RUSK ST, JACKSONVILLE, TX 75766-5505
(888) 396-3462
(214) 396-3482
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004986
STATE FACILITY LICENSE
TX
Enumeration date
05/15/2019
Last updated
08/21/2019
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