Provider Demographics
NPI:1417275900
Name:KENEDY I ENTERPRISES, LLC
Entity Type:Organization
Organization Name:KENEDY I ENTERPRISES, LLC
Other - Org Name:KENEDY HEALTH & 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:817-348-8959
Mailing Address - Street 1:P.O. DRAWER E
Mailing Address - Street 2:
Mailing Address - City:KENEDY
Mailing Address - State:TX
Mailing Address - Zip Code:78119-2729
Mailing Address - Country:US
Mailing Address - Phone:830-583-9101
Mailing Address - Fax:830-583-2962
Practice Address - Street 1:7882 S HWY 181
Practice Address - Street 2:
Practice Address - City:KENEDY
Practice Address - State:TX
Practice Address - Zip Code:78119-2729
Practice Address - Country:US
Practice Address - Phone:830-583-9101
Practice Address - Fax:830-583-2962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-10
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX004449OtherFACILITY ID
TX001018522Medicaid
676173Medicare Oscar/Certification