MEDICARE: LOCKHART I ENTERPRISES, L.L.C.

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
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1326838723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOCKHART I ENTERPRISES, L.L.C.

Provider Business Mailing Address
First Line	:	4150 INTERNATIONAL PLZ STE 200
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-4875
Country	:	US
Telephone Number	:	817-386-8410
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 N MEDINA ST
Second Line	:
City	:	LOCKHART
State	:	TX
Zip	:	78644-1919
Country	:	US
Telephone Number	:	512-398-5213
Fax Number	:	512-398-9458

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. GARY BLAKE
Credential	:
Telephone Number	:	817-348-8959

Provider Enumeration Date	:	05/08/2025
Last Update Date	:	05/08/2025

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Directions to “LOCKHART I ENTERPRISES, L.L.C. ” Practice Location

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