Organization
JEFFERSON I ENTERPRISES, LLC
Active
Other names
Pine Hill Nursing and Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BLAKE (MANAGING MEMBER)
(817) 348-8841
Entity
Organization
Contact information
Practice address
1307 MARTIN LUTHER KING DR, JEFFERSON, TX 75657-1009
(903) 665-9351
(903) 665-7230
Mailing address
1307 MARTIN LUTHER KING DR, JEFFERSON, TX 75657-1009
(903) 665-9351
(903) 665-7230
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001016514
—
TX
01
—
005288
STATE VENDOR
TX
Enumeration date
11/21/2008
Last updated
02/25/2015
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