Odessa I Enterprises, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

ODESSA I ENTERPRISES, LLC

Doing business as

Buena Vida Nursing & Rehab Odessa

Practice address

3800 Englewood LN
Odessa, TX 79762-7073

Phone

(432) 362-2583

Fax

(432) 362-8384

NPI assigned

Jun 14, 2019

Last updated

Jun 14, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gary Blake

Title

Managing Member

Phone

(817) 348-8959

Specialties & licenses 1

Addresses

Other names 1

• Buena Vida Nursing & Rehab Odessa Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560470400000",
    "number": "1770143521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3800 ENGLEWOOD LN",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797627073",
            "telephone_number": "432-362-2583",
            "fax_number": "432-362-8384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 ENGLEWOOD LN",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797627073",
            "telephone_number": "432-362-2583",
            "fax_number": "432-362-8384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ODESSA I ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-14",
        "last_updated": "2019-06-14",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "817-348-8959"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Buena Vida Nursing & Rehab Odessa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Odessa, TX
• Providers in Odessa, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.