# WOODVILLE II ENTERPRISES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Dogwood Trails Manor
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871551622
- **Authorized official:** GARY BLAKE (MANAGING MEMBER)
- **Authorized official phone:** (817) 348-8959

## Contact information

- **Practice address:** 647 US HIGHWAY 190 W, WOODVILLE, TX 75979-6758
- **Practice address phone:** (409) 283-8147
- **Practice address fax:** (409) 283-3919
- **Mailing address:** 647 US HIGHWAY 190 W, WOODVILLE, TX 75979-6758
- **Mailing address phone:** (409) 283-8147
- **Mailing address fax:** (409) 283-3919

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 111622 | TX | Yes |

## Other

- **Enumeration date:** 05/02/2006
- **Last updated:** 08/30/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 001004816 | — | TX |
| 01 | — | 005312 | VENDOR\# | TX |
| 05 | — | 170133601 | — | TX |