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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