Provider Demographics
NPI:1679630636
Name:SELMAN I ENTERPRISES, LLC
Entity Type:Organization
Organization Name:SELMAN I ENTERPRISES, LLC
Other - Org Name:SONGBIRD ASSISTED LIVING
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:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:SELMAN CITY
Mailing Address - State:TX
Mailing Address - Zip Code:75689-0254
Mailing Address - Country:US
Mailing Address - Phone:903-847-3912
Mailing Address - Fax:903-847-2114
Practice Address - Street 1:9718 HWY 64 WEST
Practice Address - Street 2:
Practice Address - City:OVERTON
Practice Address - State:TX
Practice Address - Zip Code:75684-9801
Practice Address - Country:US
Practice Address - Phone:903-847-3912
Practice Address - Fax:903-847-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000751310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility