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General NPI Number Information
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NPI Number | 1780576181
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Entity Type | Organization
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Legal Business Name | CORSICANA III ENTERPRISES, L.L.C.
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 3002 W 2ND AVE
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City | CORSICANA
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State | TX
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Zip | 75110-2492
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Country | US
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Telephone | 903-872-5130
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Fax |
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Provider Business Mailing Address
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Address Line | 4150 INTERNATIONAL PLZ STE 200
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City | FORT WORTH
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State | TX
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Zip | 76109-4875
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Country | US
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Telephone | 817-386-8410
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Fax |
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Authorized Official
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Title or Position | MANAGER
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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 |
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