# KENEDY I ENTERPRISES, LLC

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

## Provider details

- **NPI number:** 1417275900
- **Authorized official:** GARY BLAKE (MANAGING MEMBER)
- **Authorized official phone:** (817) 348-8959

## Contact information

- **Practice address:** 7882 S HWY 181, KENEDY, TX 78119-2729
- **Practice address phone:** (830) 583-9101
- **Practice address fax:** (830) 583-2962
- **Mailing address:** P.O. DRAWER E, KENEDY, TX 78119-2729
- **Mailing address phone:** (830) 583-9101
- **Mailing address fax:** (830) 583-2962

## Taxonomy

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

## Other

- **Enumeration date:** 05/10/2010
- **Last updated:** 08/30/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001018522 | — | TX |
| 01 | — | 004449 | FACILITY ID | TX |