Provider Demographics
NPI:1134300072
Name:WOODVILLE I ENTERPRISES, LLC
Entity Type:Organization
Organization Name:WOODVILLE I ENTERPRISES, LLC
Other - Org Name:THE ORCHARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-832-3654
Mailing Address - Street 1:805 W DOGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75979-4700
Mailing Address - Country:US
Mailing Address - Phone:409-283-5678
Mailing Address - Fax:409-283-2044
Practice Address - Street 1:805 W DOGWOOD ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-4700
Practice Address - Country:US
Practice Address - Phone:409-283-5678
Practice Address - Fax:409-283-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility