# GREENVILLE I ENTERPRISES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Park Haven Nursing and Rehabilitation
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174897730
- **Authorized official:** MR. GARY BLAKE (MANAGING MEMBER)
- **Authorized official phone:** (817) 348-8841

## Contact information

- **Practice address:** 3500 PARK ST, GREENVILLE, TX 75401-5159
- **Practice address phone:** (903) 455-2220
- **Practice address fax:** (903) 455-0343
- **Mailing address:** 3500 PARK ST, GREENVILLE, TX 75401-5159
- **Mailing address phone:** (903) 455-2220
- **Mailing address fax:** (903) 455-0343

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 02/29/2012
- **Last updated:** 07/09/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001020376 | — | TX |
| 01 | — | 004381 | FACILITY ID | TX |