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Organization
MADISONVILLE II ENTERPRISES, LLC
Active
Organization
MADISONVILLE II ENTERPRISES, LLC
Active
Other names
Madisonville Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY BLAKE (MANAGING MEMBER)
(817) 348-8959
Entity
Organization
Contact information
Practice address
411 E. COLLARD ST., MADISONVILLE, TX 77864-3306
(936) 348-2735
(936) 348-6401
Mailing address
4150 INTERNATIONAL PLAZA, SUITE 600, FORT WORTH, TX 76109-4831
(817) 348-8959
(817) 348-0466
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001015682
—
TX
01
—
004314
DADS VENDOR
—
Enumeration date
12/14/2007
Last updated
04/13/2022
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