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NPI Code Detail

MEDICARE: BOB & NICK ENTERPRISES, INC

MEDICARE: BOB & NICK ENTERPRISES, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility117694TX

General Provider Information

NPI Number : 1306922133
Entity Type Code : Organization
Provider Name (Legal Business Name) : BOB & NICK ENTERPRISES, INC
Provider Business Mailing Address
First Line : 1405 W STOREY ST
Second Line :
City : SAN SABA
State : TX
Zip : 76877-6422
Country : US
Telephone Number : 325-372-3675
Fax Number : 325-372-5114
Provider Business Practice Location Address
First Line : 1405 W STOREY ST
Second Line :
City : SAN SABA
State : TX
Zip : 76877-6422
Country : US
Telephone Number : 325-372-3675
Fax Number : 325-372-5114
Authorized Official
Title or Position : ADMINISTRATOR
Name : MISS ENEDINA M DIAZ
Credential : LNFA
Telephone Number : 325-372-5112
Provider Enumeration Date : 10/27/2006
Last Update Date : 08/22/2020

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Directions to “BOB & NICK ENTERPRISES, INC ” Practice Location

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