Healthcare Provider Details

I. General information

NPI: 1942446133
Provider Name (Legal Business Name): AMARILLO VI ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 SW 46TH AVE
AMARILLO TX
79110-1735
US

IV. Provider business mailing address

2611 SW 46TH AVE
AMARILLO TX
79110-1735
US

V. Phone/Fax

Practice location:
  • Phone: 806-355-6517
  • Fax: 806-355-4190
Mailing address:
  • Phone: 806-355-6517
  • Fax: 806-355-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: GARY BLAKE
Title or Position: MANAGING MEMBER
Credential:
Phone: 817-348-8959