Organization
BLENDED HEALTH LLC
Active
Other names
Cypress Glen East Nursing & Rehab
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES W MOORE SR. (OWNER)
(409) 962-0910
Entity
Organization
Contact information
Practice address
4225 LAKE ARTHUR DR, PORT ARTHUR, TX 77642-6490
(409) 727-3193
(409) 727-4777
Mailing address
4225 LAKE ARTHUR DR, PORT ARTHUR, TX 77642-6490
(409) 727-3193
(409) 727-4777
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
113493
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001012145
—
TX
Enumeration date
12/07/2005
Last updated
05/28/2010
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