Healthcare Provider Details

I. General information

NPI: 1447851480
Provider Name (Legal Business Name): COOPER I ENTERPRISES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HIGHWAY 64 W
COOPER TX
75432-9734
US

IV. Provider business mailing address

4150 INTERNATIONAL PLZ STE 600
FT WORTH TX
76109-4831
US

V. Phone/Fax

Practice location:
  • Phone: 903-395-2125
  • Fax:
Mailing address:
  • Phone: 817-348-8959
  • Fax:

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