Healthcare Provider Details

I. General information

NPI: 1780433441
Provider Name (Legal Business Name): LANCASTER I ENTERPRISES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N ELM ST
LANCASTER TX
75134-3241
US

IV. Provider business mailing address

4150 INTERNATIONAL PLZ STE 200
FORT WORTH TX
76109-4875
US

V. Phone/Fax

Practice location:
  • Phone: 972-227-6066
  • Fax: 972-227-0970
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