=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669746210
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DUMAS I ENTERPRISES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/29/2012
-----------------------------------------------------
Last Update Date | 08/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 315 E 19TH ST
-----------------------------------------------------
City | DUMAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79029-5657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-935-4143
-----------------------------------------------------
Fax | 806-935-7988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 315 E 19TH ST
-----------------------------------------------------
City | DUMAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79029-5657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-935-4143
-----------------------------------------------------
Fax | 806-935-7988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING MEMBER
-----------------------------------------------------
Name | GARY BLAKE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-348-8959
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------