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General NPI Number Information
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NPI Number | 1003198383
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Entity Type | Organization
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Legal Business Name | BURNET I ENTERPRISES, LLC
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 04/10/2012
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Provider Practice Location Address
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Address Line | 507 W JACKSON ST
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City | BURNET
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State | TX
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Zip | 78611-3012
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Country | US
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Telephone | 512-756-6044
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Fax | 512-756-2646
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Provider Business Mailing Address
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Address Line | 507 W JACKSON ST
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City | BURNET
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State | TX
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Zip | 78611-3012
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Country | US
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Telephone | 512-756-6044
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Fax | 512-756-2646
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. GARY BLAKE
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Credential |
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Telephone | 817-348-8841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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