Organization
EL PASO V ENTERPRISES, LLC
Active
Other names
Pebble Creek Nursing Center
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BLAKE (MANAGING MEMBER)
(817) 348-8959
Entity
Organization
Contact information
Practice address
11608 SCOTT SIMPSON DR, EL PASO, TX 79936-6210
(915) 857-0071
(915) 857-0118
Mailing address
4150 INTERNATIONAL PLZ STE 600, FORT WORTH, TX 76109-4831
(915) 857-0071
(915) 857-0118
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
08/24/2018
Last updated
08/24/2018
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