Healthcare Provider Details

I. General information

NPI: 1588718845
Provider Name (Legal Business Name): TEAGUE I ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 US HWY 84 W
TEAGUE TX
75860-5142
US

IV. Provider business mailing address

884 US HWY 84 W
TEAGUE TX
75860-5142
US

V. Phone/Fax

Practice location:
  • Phone: 254-739-2541
  • Fax: 254-739-5233
Mailing address:
  • Phone: 254-739-2541
  • Fax: 254-739-5233

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