Organization
KILGORE I ENTERPRISES, LLC
Active
Other names
Kilgore Health & Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BLAKE (MANAGING MEMBER)
(817) 348-8841
Entity
Organization
Contact information
Practice address
2700 S HENDERSON BLVD, KILGORE, TX 75662-4033
(903) 984-3511
(903) 983-1031
Mailing address
2700 S HENDERSON BLVD, KILGORE, TX 75662-4033
(903) 984-3511
(903) 983-1031
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001018457
—
TX
01
—
004515
FACILITY ID
TX
Enumeration date
04/20/2010
Last updated
02/25/2015
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