Organization
MADISONVILLE II ENTERPRISES, LLC
Active
Other names
Madisonville Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY BLAKE (MANAGING MEMBER)
(817) 348-8959
Entity
Organization
Contact information
Practice address
411 E. COLLARD ST., MADISONVILLE, TX 77864-3306
(936) 348-2735
(936) 348-6401
Mailing address
4150 INTERNATIONAL PLAZA, SUITE 600, FORT WORTH, TX 76109-4831
(817) 348-8959
(817) 348-0466
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001015682
—
TX
01
—
004314
DADS VENDOR
—
Enumeration date
12/14/2007
Last updated
04/13/2022
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