Provider Demographics
NPI:1083011787
Name:KILGORE HEALTHCARE LLC
Entity type:Organization
Organization Name:KILGORE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOL
Authorized Official - Middle Name:
Authorized Official - Last Name:GURWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-984-3511
Mailing Address - Street 1:8383 WILSHIRE BLVD
Mailing Address - Street 2:STE 830
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2425
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 S HENDERSON BLVD
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-4033
Practice Address - Country:US
Practice Address - Phone:903-984-3511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-24
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001026513Medicaid
TX675814Medicare Oscar/Certification