Healthcare Provider Details

I. General information

NPI: 1003198383
Provider Name (Legal Business Name): BURNET I ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 W JACKSON ST
BURNET TX
78611-3012
US

IV. Provider business mailing address

507 W JACKSON ST
BURNET TX
78611-3012
US

V. Phone/Fax

Practice location:
  • Phone: 512-756-6044
  • Fax: 512-756-2646
Mailing address:
  • Phone: 512-756-6044
  • Fax: 512-756-2646

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 BLAKE
Title or Position: MANAGING MEMBER
Credential:
Phone: 817-348-8841