Organization
LUBBOCK III ENTERPRISES, LLC
Active
Other names
Lubbock Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY BLAKE (MANAGING MEMBER)
(817) 348-8959
Entity
Organization
Contact information
Practice address
4120 22ND PL, LUBBOCK, TX 79410-1122
(806) 793-3252
(806) 791-5364
Mailing address
4120 22ND PL, LUBBOCK, TX 79410-1122
(806) 793-3252
(806) 791-5364
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001025706
—
TX
01
—
005138
DADS FACILITY ID
TX
Enumeration date
12/16/2013
Last updated
08/30/2021
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