NPIMap

Organization Active NPI

El Paso V Enterprises, LLC

Doing business as Pebble Creek Nursing Center

  • Skilled Nursing Facility
  • El Paso, TX
National Provider Identifier
1699256982
Registry record updated Aug 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EL PASO V ENTERPRISES, LLC
Doing business as
Pebble Creek Nursing Center
Practice address
11608 Scott Simpson Dr
El Paso, TX 79936-6210
Phone
(915) 857-0071
Fax
(915) 857-0118
NPI assigned
Aug 24, 2018
Last updated
Aug 24, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2018

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

Authorized official

Name
Gary Blake
Title
Managing Member
Phone
(817) 348-8959

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

11608 Scott Simpson Dr
El Paso, TX 79936-6210

Mailing address

4150 International PLZ Ste 600
Fort Worth, TX 76109-4831
Phone (915) 857-0071

Other names 1

  • Pebble Creek Nursing Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190620000181 TX Part A Provider - Skilled Nursing Facility 6608128400 Practice locations: El Paso, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699256982. Details of each certification follow.

Skilled nursing facility certification: CCN 455718

Legal name
EL PASO V ENTERPRISES, LLC
Doing business as
PEBBLE CREEK NURSING CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Nov 13, 1987
Last certification
May 16, 2024
Beds
120
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
Oct 1, 2018
Organization structure
LLCProprietary
Enrollment address
11608 Scott Simpson Dr
El Paso, TX 79936-6210
Nursing home name
PEBBLE CREEK NURSING CENTER
Affiliated entity
CREATIVE SOLUTIONS IN HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pebble Creek Nursing CenterCCN 455718 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Nov 13, 1987
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
12091.7 residents per day on average
Chain
Creative Solutions in Healthcare149 facilities in the chain
Special focus status
SFF Candidate
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
3Fines totaling $145,184

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Malisa a Blake Individual 5% Or Greater Indirect Ownership InterestMember Oct 1, 2018 50%
Operational/Managerial ControlMember Oct 1, 2018 50%
Gary R Blake Individual 5% Or Greater Indirect Ownership InterestManaging Member Oct 1, 2018 50%
Operational/Managerial ControlManaging Member Oct 1, 2018 50%
Linda F Huggins Individual W-2 Managing EmployeeVP of Accounts Receivable Oct 1, 2018
Honor X Enterprises, LLC Organization, Fort Worth, TX LLC, For-profit 5% Or Greater Direct Ownership Interest Oct 1, 2018 100%
Creative Solutions in Healthcare Inc Organization, Fort Worth, TX Corporation, Management services company, For-profit Operational/Managerial Control Oct 1, 2018 100%

Facilities with the same owner 45

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

View all 45

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 2

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": "1535068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535068800000",
    "number": "1699256982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 INTERNATIONAL PLZ STE 600",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094831",
            "telephone_number": "915-857-0071",
            "fax_number": "915-857-0118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11608 SCOTT SIMPSON DR",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799366210",
            "telephone_number": "915-857-0071",
            "fax_number": "915-857-0118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL PASO V ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-24",
        "last_updated": "2018-08-24",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "817-348-8959"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pebble Creek Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.