Organization
ROSEBUD I ENTERPRISES, LLC
Active
Other names
Heritage House Nursing and Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY BLAKE (MANAGING MEMBER)
(817) 348-8959
Entity
Organization
Contact information
Practice address
407 N COLLEGE, ROSEBUD, TX 76570-2292
(254) 583-7904
(254) 583-2830
Mailing address
407 N COLLEGE, ROSEBUD, TX 76570-2292
(254) 583-7904
(254) 583-2830
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001019892
—
TX
01
—
004857
MEDICAID VENDOR #
TX
Enumeration date
08/29/2011
Last updated
08/30/2021
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