NPIMap

Organization Active NPI

Stephens Memorial Hospital District

Doing business as Park Village Healthcare and Rehabilitation

  • Skilled Nursing Facility
  • Desoto, TX
National Provider Identifier
1225022908
Registry record updated Oct 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
111200 Issued in TX
Legal business name
STEPHENS MEMORIAL HOSPITAL DISTRICT
Doing business as
Park Village Healthcare and Rehabilitation
Practice address
207 E Parkerville Rd
Desoto, TX 75115-6251
Phone
(972) 230-1000
Fax
(972) 230-5509
NPI assigned
Sep 8, 2005
Last updated
Oct 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2021

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

Authorized official

Name
Soon Burnam
Title
Authorized Agent
Phone
(949) 540-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 111200 TX Primary

Addresses

Primary practice location

207 E Parkerville Rd
Desoto, TX 75115-6251

Mailing address

207 E Parkerville Rd
Desoto, TX 75115-6251
Phone (972) 230-1000

Other identifiers 1

IdentifierTypeStateIssuer
5257MedicaidTX

Other names 1

  • Park Village Healthcare and Rehabilitation Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170919001036 TX Part A Provider - Skilled Nursing Facility 4688801715 Practice locations: Desoto, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225022908. Details of each certification follow.

Skilled nursing facility certification: CCN 455727

Legal name
STEPHENS MEMORIAL HOSPITAL DISTRICT
Doing business as
PARK VILLAGE HEALTHCARE AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Nov 12, 1987
Last certification
Mar 24, 2025
Beds
150
Ownership / control type
Limited Liability Corporation
Organization structure
OtherNon-profit
Enrollment address
207 E Parkerville Rd
Desoto, TX 75115-6251
Nursing home name
PARK VILLAGE HEALTHCARE AND REHABILITATION
Affiliated entity
THE ENSIGN GROUP

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Park Village Healthcare and RehabilitationCCN 455727 · All quality measures
Overall star rating
2 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Nov 12, 1987
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
150106.2 residents per day on average
Chain
The Ensign Group342 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
6Fines totaling $221,389

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Stephens Memorial Hosp Dist12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Thorntree Healthcare, Inc. Organization, Desoto, TX Corporation Operational/Managerial Control Oct 1, 2021
Adp of the SNF Oct 20, 2025
Sabra Health Care Reit Inc Organization, Tustin, CA Adp of the SNF Oct 1, 2021
Gena Speer Individual Corporate OfficerCeo Stephens Memorial Hosp District Mar 27, 2025
Brian Roland Individual Operational/Managerial Control Mar 1, 2021
Managing Control - Governing BodyAdministrator Mar 1, 2021
Adp of the SNF Mar 1, 2021
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Jul 8, 2021
Stephens Memorial Hospital District Organization, Breckenridge, TX 5% Or Greater Direct Ownership Interest Oct 1, 2021 100%
Chad Keetch Individual Corporate OfficerSecretary Ensign Services, Inc. Mar 1, 2011
Gene Bigham Individual Operational/Managerial Control Dec 1, 2023
Managing Control - Governing BodyMedical Director Dec 1, 2023
Adp of the SNF Dec 1, 2023
Soon Burnam Individual Corporate OfficerSecretary of Management Company Oct 1, 2021

Owners & managing parties with NPI records 12

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 10

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Stephens Memorial HospitalBreckenridge, TX, CCN 671302 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2025
Stephens Memorial HospitalBreckenridge, TX, CCN 67Z302 Hospital 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2013
Avir at StephenvilleStephenville, TX, CCN 455744 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Feb 28, 2015
Heritage at Turner Park Health & RehabGrand Prairie, TX, CCN 455733 Skilled nursing facility 5% Or Greater Indirect Ownership Interest (100%) Apr 1, 2017
Cedar Hill Healthcare CenterCedar Hill, TX, CCN 675032 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2017
Avir at BairdBaird, TX, CCN 675364 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 1, 2017
Reunion Plaza Healthcare & RehabilitationTyler, TX, CCN 675888 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2022
Mabank Nursing CenterMabank, TX, CCN 676458 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2022
Briarcliff Health Center of GreenvilleGreenville, TX, CCN 675666 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2023
Breckenridge Medical CenterBreckenridge, TX, CCN 458881 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2013

Owned or controlled facilities with NPI records 10

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633910400000",
    "number": "1225022908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 E PARKERVILLE RD",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751156251",
            "telephone_number": "972-230-1000",
            "fax_number": "972-230-5509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 E PARKERVILLE RD",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751156251",
            "telephone_number": "972-230-1000",
            "fax_number": "972-230-5509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHENS MEMORIAL HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-08",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TX",
            "license": "111200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5257",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Village Healthcare and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Desoto, TX

Sources for this page

Verify at the official NPI Registry.