Provider Demographics
NPI:1326234246
Name:TYLER I ENTERPRISES, LLC
Entity Type:Organization
Organization Name:TYLER I ENTERPRISES, LLC
Other - Org Name:VILLA OF TYLER BUILDINGS 1,2,3,4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-832-3654
Mailing Address - Street 1:3323 GARDEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-3704
Mailing Address - Country:US
Mailing Address - Phone:903-592-8852
Mailing Address - Fax:903-533-1565
Practice Address - Street 1:3323 GARDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-3704
Practice Address - Country:US
Practice Address - Phone:903-592-8852
Practice Address - Fax:903-533-1565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility