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Organization
WOODVILLE II ENTERPRISES, LLC
Active
Organization
WOODVILLE II ENTERPRISES, LLC
Active
Other names
Dogwood Trails Manor
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BLAKE (MANAGING MEMBER)
(817) 348-8959
Entity
Organization
Contact information
Practice address
647 US HIGHWAY 190 W, WOODVILLE, TX 75979-6758
(409) 283-8147
(409) 283-3919
Mailing address
647 US HIGHWAY 190 W, WOODVILLE, TX 75979-6758
(409) 283-8147
(409) 283-3919
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
111622
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001004816
—
TX
01
—
005312
VENDOR#
TX
05
—
170133601
—
TX
Enumeration date
05/02/2006
Last updated
08/30/2021
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