Provider Demographics
NPI:1568808004
Name:SILSBEE I ENTERPRISES, LLC
Entity Type:Organization
Organization Name:SILSBEE I ENTERPRISES, LLC
Other - Org Name:SPANISH TRAIL ASSISTED LIVING OF SILSBEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-348-8841
Mailing Address - Street 1:775 HWY 96 S
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-5512
Mailing Address - Country:US
Mailing Address - Phone:409-373-6305
Mailing Address - Fax:409-373-6334
Practice Address - Street 1:775 HWY 96 S
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-5512
Practice Address - Country:US
Practice Address - Phone:409-373-6305
Practice Address - Fax:409-373-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5512Other4 DIGIT ZIP CODE
TX105600OtherFACILITY ID