Organization
MADISONVILLE III ENTERPRISES, LLC
Active
Other names
Madisonville Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BLAKE (MANAGING MEMBER)
(817) 348-8841
Entity
Organization
Contact information
Practice address
410 E COLLARD ST, MADISONVILLE, TX 77864-3307
(936) 348-3985
(936) 348-3501
Mailing address
410 E COLLARD ST, MADISONVILLE, TX 77864-3307
(936) 348-3985
(936) 348-3501
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
123702
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123702
DEPT AGING & DISABILITY LICENSE
TX
Enumeration date
05/09/2008
Last updated
05/09/2008
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