Organization
GROVETON I ENTERPRISES, LLC
Active
Other names
Groveton Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BLAKE (MANAGING MEMBER)
(817) 348-8841
Entity
Organization
Contact information
Practice address
1020 W 1ST STREET, GROVETON, TX 75845
(936) 642-1221
(936) 642-2727
Mailing address
PO BOX 890, GROVETON, TX 75845-0890
(936) 642-1221
(936) 642-2727
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000502
STATE VENDOR
TX
Enumeration date
09/30/2008
Last updated
09/30/2008
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