Organization
MEMPHIS I ENTERPRISES, LLC
Active
Other names
Memphis Convalescent Center
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BLAKE (MANAGING MEMBER)
(817) 348-8959
Entity
Organization
Contact information
Practice address
1415 N 18TH ST, MEMPHIS, TX 79245-2009
(806) 259-3566
(806) 259-5098
Mailing address
1415 N 18TH ST, MEMPHIS, TX 79245-2009
(806) 259-3566
(806) 259-5098
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001016680
—
TX
01
—
005131
VENDOR
—
Enumeration date
12/18/2008
Last updated
08/30/2021
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