Organization
NACOGDOCHES CSNHC ENTERPRISES, LLC
Active
Other names
Willowbrook Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BLAKE (MANAGING MEMBER)
(817) 348-8959
Entity
Organization
Contact information
Practice address
227 RUSSELL BLVD, NACOGDOCHES, TX 75965-1238
(936) 564-4596
(936) 564-6824
Mailing address
227 RUSSELL BLVD, NACOGDOCHES, TX 75965-1238
(936) 564-4596
(936) 564-6824
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001015998
—
TX
01
—
005225
VENDOR STATE
TX
Enumeration date
02/27/2008
Last updated
02/06/2015
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