Healthcare Provider Details

I. General information

NPI: 1427374107
Provider Name (Legal Business Name): CUERO I ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 MC ARTHUR ST
CUERO TX
77954-2317
US

IV. Provider business mailing address

1010 MC ARTHUR ST
CUERO TX
77954-2317
US

V. Phone/Fax

Practice location:
  • Phone: 361-277-6133
  • Fax: 361-275-6169
Mailing address:
  • Phone: 361-277-6133
  • Fax: 361-275-6169

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: 817-348-8841