# SAN ANGELO I ENTERPRISES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Park Plaza Nursing and Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265125041
- **Authorized official:** GARY BLAKE (MANAGING MEMBER)
- **Authorized official phone:** (817) 348-8959

## Contact information

- **Practice address:** 2210 HOWARD ST, SAN ANGELO, TX 76901-1318
- **Practice address phone:** (325) 944-0561
- **Practice address fax:** (325) 944-0562
- **Mailing address:** 4150 INTERNATIONAL PLZ STE 600, FORT WORTH, TX 76109-4831
- **Mailing address phone:** (817) 348-8959

## Taxonomy

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

## Other

- **Enumeration date:** 05/30/2023
- **Last updated:** 05/30/2023