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General NPI Number Information
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NPI Number | 1619113644
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Entity Type | Organization
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Legal Business Name | MCLEAN I ENTERPRISES, LLC
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Dates
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Enumeration Date | 12/22/2008
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 605 W SEVENTH ST
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City | MCLEAN
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State | TX
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Zip | 79057-0780
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Country | US
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Telephone | 806-779-2469
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Fax | 806-779-2515
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Provider Business Mailing Address
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Address Line | PO BOX 780
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City | MCLEAN
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State | TX
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Zip | 79057-0780
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Country | US
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Telephone | 806-779-2469
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Fax | 806-779-2515
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | GARY BLAKE
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Credential |
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Telephone | 817-348-8959
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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 | TX
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