Kilgore I Enterprises, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

KILGORE I ENTERPRISES, LLC

Doing business as

Kilgore Health & Rehabilitation

Practice address

2700 S Henderson Blvd
Kilgore, TX 75662-4033

Phone

(903) 984-3511

Fax

(903) 983-1031

NPI assigned

Apr 20, 2010

Last updated

Feb 25, 2015By 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) 348-8841

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kilgore Health & Rehabilitation Doing business as

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

{
    "created_epoch": "1271721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424822400000",
    "number": "1992021661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 S HENDERSON BLVD",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756624033",
            "telephone_number": "903-984-3511",
            "fax_number": "903-983-1031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 S HENDERSON BLVD",
            "city": "KILGORE",
            "state": "TX",
            "postal_code": "756624033",
            "telephone_number": "903-984-3511",
            "fax_number": "903-983-1031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KILGORE I ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-20",
        "last_updated": "2015-02-25",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "817-348-8841"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001018457",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FACILITY ID",
            "identifier": "004515",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kilgore Health & Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alaina Jordan, LCDC
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• Kilgore Chiropractic Clinic Inc
• Kilgore Healthcare LLC
• Kilgore Independent School District
• Kilgore Integrated Health PLLC
• Kilgore Life Center
• Kilgore Manor Inc (Legacy Living Centers)
• Kilgore Spine and Joint PLLC

• Skilled Nursing Facility in Kilgore, TX
• Providers in Kilgore, 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 Feb 25, 2015; 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.