MEDICARE: EAGLE PASS I ENTERPRISES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	005009	OTHER	TX	FACILITY ID

General Provider Information

NPI Number	:	1225309172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAGLE PASS I ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	2550 ZACATECAS DR
Second Line	:
City	:	EAGLE PASS
State	:	TX
Zip	:	78852-4129
Country	:	US
Telephone Number	:	830-773-4488
Fax Number	:	830-773-9681

Provider Business Practice Location Address
First Line	:	2550 ZACATECAS DR
Second Line	:
City	:	EAGLE PASS
State	:	TX
Zip	:	78852-4129
Country	:	US
Telephone Number	:	830-773-4488
Fax Number	:	830-773-9681

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. GARY BLAKE
Credential	:
Telephone Number	:	817-348-8959

Provider Enumeration Date	:	01/24/2012
Last Update Date	:	08/30/2021

Similar Medicare Providers

1548257033 — EAGLE PASS NURSING AND REHABILITATION LP
Practice Location Address:

2550 ZACATECAS DR
EAGLE PASS, TX
78852-4129

Practice Phone: 830-773-4488
Practice Fax: 830-773-9681

1851959779 — NATALEE JACQUELINE ARREDONDO COTA
Practice Location Address:

2550 ZACATECAS DR
EAGLE PASS, TX
78852-4129

Practice Phone: 830-773-4488
Practice Fax:

1750342440 — TEAM REHAB PC
Practice Location Address:

22 EAGLE RD
DANBURY, CT
06810-4129

Practice Phone: 203-778-8326
Practice Fax: 203-792-9170

1710928791 — MS. PATRICIA ANN HOLLAND PT
Practice Location Address:

22 EAGLE RD
DANBURY, CT
06810-4129

Practice Phone: 203-778-8326
Practice Fax: 203-792-9170

1710928742 — MS. JILL M MALONEY PT
Practice Location Address:

22 EAGLE RD
DANBURY, CT
06810-4129

Practice Phone: 203-778-8326
Practice Fax: 203-792-9170

1417998857 — MR. STEPHEN MERKLE MS PT OCS
Practice Location Address:

22 EAGLE RD
DANBURY, CT
06810-4129

Practice Phone: 203-778-8326
Practice Fax: 203-792-9170

Directions to “EAGLE PASS I ENTERPRISES, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.