Healthcare Provider Details

I. General information

NPI: 1326838723
Provider Name (Legal Business Name): LOCKHART I ENTERPRISES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N MEDINA ST
LOCKHART TX
78644-1919
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 512-398-5213
  • Fax: 512-398-9458
Mailing address:
  • Phone: 817-386-8410
  • 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: MR. GARY BLAKE
Title or Position: MANAGER
Credential:
Phone: 817-348-8959