Greenville I Enterprises LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

GREENVILLE I ENTERPRISES LLC

Practice address

3500 Park St
Greenville, TX 75401-5159

Phone

(903) 455-2220

Fax

(903) 455-0343

NPI assigned

Feb 29, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Gary Blake

Title

Managing Member

Phone

(817) 348-8841

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Park Haven Nursing and Rehabilitation Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1330473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341792000000",
    "number": "1174897730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 PARK ST",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754015159",
            "telephone_number": "903-455-2220",
            "fax_number": "903-455-0343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 PARK ST",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754015159",
            "telephone_number": "903-455-2220",
            "fax_number": "903-455-0343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREENVILLE I ENTERPRISES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-29",
        "last_updated": "2012-07-09",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "817-348-8841",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FACILITY ID",
            "identifier": "004381",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001020376",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Haven Nursing and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Greenville, TX
• Providers in Greenville, TX by specialty
• Skilled Nursing Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.