Organization
GREENVILLE I ENTERPRISES LLC
Active
Other names
Park Haven Nursing and Rehabilitation
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY BLAKE (MANAGING MEMBER)
(817) 348-8841
Entity
Organization
Contact information
Practice address
3500 PARK ST, GREENVILLE, TX 75401-5159
(903) 455-2220
(903) 455-0343
Mailing address
3500 PARK ST, GREENVILLE, TX 75401-5159
(903) 455-2220
(903) 455-0343
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001020376
—
TX
01
—
004381
FACILITY ID
TX
Enumeration date
02/29/2012
Last updated
07/09/2012
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