# KILGORE I ENTERPRISES, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1992021661
- **Authorized official:** GARY BLAKE (MANAGING MEMBER)
- **Authorized official phone:** (817) 348-8841

## Contact information

- **Practice address:** 2700 S HENDERSON BLVD, KILGORE, TX 75662-4033
- **Practice address phone:** (903) 984-3511
- **Practice address fax:** (903) 983-1031
- **Mailing address:** 2700 S HENDERSON BLVD, KILGORE, TX 75662-4033
- **Mailing address phone:** (903) 984-3511
- **Mailing address fax:** (903) 983-1031

## Taxonomy

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

## Other

- **Enumeration date:** 04/20/2010
- **Last updated:** 02/25/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001018457 | — | TX |
| 01 | — | 004515 | FACILITY ID | TX |