Provider Demographics
NPI:1346561149
Name:HEREFORD I ENTERPRISES, LLC
Entity Type:Organization
Organization Name:HEREFORD I ENTERPRISES, LLC
Other - Org Name:HEREFORD NURSING & REHABILITATION
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:817-348-8841
Mailing Address - Street 1:231 KINGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:TX
Mailing Address - Zip Code:79045-3816
Mailing Address - Country:US
Mailing Address - Phone:806-364-7113
Mailing Address - Fax:806-364-0340
Practice Address - Street 1:231 KINGWOOD ST
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045-3816
Practice Address - Country:US
Practice Address - Phone:806-364-7113
Practice Address - Fax:806-364-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
005320OtherFACILITY ID