# BANDERA I ENTERPRISES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Cedar Creek Nursing and Rehabilitation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487992418
- **Authorized official:** MR. GARY BLAKE (MANAGING MEMBER)
- **Authorized official phone:** (817) 348-8959

## Contact information

- **Practice address:** 159 MONTAGUE AVE, BANDERA, TX 78003-0000
- **Practice address phone:** (830) 460-3767
- **Practice address fax:** (830) 796-4791
- **Mailing address:** 159 MONTAGUE AVE, BANDERA, TX 78003-0000
- **Mailing address phone:** (830) 460-3767
- **Mailing address fax:** (830) 796-4791

## Taxonomy

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

## Other

- **Enumeration date:** 01/25/2013
- **Last updated:** 08/30/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001021028 | — | TX |
| 01 | — | 004537 | DADS FACID | TX |