# GOLDTHWAITE I ENTERPRISES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Goldthwaite Health & Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205069101
- **Authorized official:** GARY BLAKE (MANAGING MEMBER)
- **Authorized official phone:** (817) 348-8841

## Contact information

- **Practice address:** 1207 REYNOLDS ST, GOLDTHWAITE, TX 76844-2475
- **Practice address phone:** (325) 648-2258
- **Practice address fax:** (325) 648-3496
- **Mailing address:** 1207 REYNOLDS ST, GOLDTHWAITE, TX 76844-2475
- **Mailing address phone:** (325) 648-2258
- **Mailing address fax:** (325) 648-3496

## Taxonomy

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

## Other

- **Enumeration date:** 08/26/2009
- **Last updated:** 02/25/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001017724 | — | TX |
| 01 | — | 004411 | STATE LICENSE | TX |