Healthcare Provider Details

I. General information

NPI: 1952596009
Provider Name (Legal Business Name): WOLFFORTH I ENTERPRISES, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E 5TH ST
WOLFFORTH TX
79382-2195
US

IV. Provider business mailing address

301 E 5TH ST
WOLFFORTH TX
79382
US

V. Phone/Fax

Practice location:
  • Phone: 806-866-4666
  • Fax: 806-866-4111
Mailing address:
  • Phone: 806-866-4666
  • Fax: 806-866-4111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: GARY BLAKE
Title or Position: MANAGING MEMBER
Credential:
Phone: 817-832-3654