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Organization

BANDERA I ENTERPRISES, LLC

Active
Other names
Cedar Creek Nursing and Rehabilitation Center
Organization subpart
No

Provider details

NPI number
Authorized official
MR. GARY BLAKE (MANAGING MEMBER)
(817) 348-8959
Entity
Organization

Contact information

Practice address
159 MONTAGUE AVE, BANDERA, TX 78003-0000
(830) 460-3767
(830) 796-4791
Mailing address
159 MONTAGUE AVE, BANDERA, TX 78003-0000
(830) 460-3767
(830) 796-4791

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001021028
TX
01
004537
DADS FACID
TX
Enumeration date
01/25/2013
Last updated
08/30/2021
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