Organization
GARDENDALE HH OPCO LLC
Active
Other names
Gardendale Healthcare Residence
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL LITTLE (MANAGER)
(888) 396-3462
Entity
Organization
Contact information
Practice address
1521 E RUSK ST, JACKSONVILLE, TX 75766-5505
(903) 586-3626
(903) 586-2766
Mailing address
1521 E RUSK ST, JACKSONVILLE, TX 75766-5505
(888) 396-3462
(214) 396-3482
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004986
STATE FACILITY LICENSE
TX
Enumeration date
05/15/2019
Last updated
08/21/2019
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