# GLEN ROSE I ENTERPRISES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cherokee Rose Nursing and Rehabilitation
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114200805
- **Authorized official:** GARY BLAKE (MANAGING MEMBER)
- **Authorized official phone:** (817) 348-8959

## Contact information

- **Practice address:** 203 GIBBS BLVD, GLEN ROSE, TX 76043-4309
- **Practice address phone:** (254) 897-7361
- **Practice address fax:** (254) 897-3970
- **Mailing address:** 203 GIBBS BLVD, GLEN ROSE, TX 76043-4309
- **Mailing address phone:** (254) 897-7361
- **Mailing address fax:** (254) 897-3970

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 09/20/2011
- **Last updated:** 08/30/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001019945 | — | TX |
| 01 | — | 005306 | FACILITY ID | TX |