Healthcare Provider Details

I. General information

NPI: 1437567096
Provider Name (Legal Business Name): BIG SPRING I ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 WASSON RD
BIG SPRING TX
79720-0000
US

IV. Provider business mailing address

3701 WASSON RD
BIG SPRING TX
79720-0000
US

V. Phone/Fax

Practice location:
  • Phone: 817-348-8959
  • Fax: 817-348-0466
Mailing address:
  • Phone: 817-348-8959
  • Fax: 817-348-0466

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: MR. GARY R BLAKE
Title or Position: MANAGING MEMBER
Credential:
Phone: 817-348-8959