NPIMap

Organization Active NPI

Desoto II Enterprises, LLC

  • Skilled Nursing Facility
  • Desoto, TX
National Provider Identifier
1700635463
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
DESOTO II ENTERPRISES, LLC
Practice address
1101 N Hampton Rd
Desoto, TX 75115-3951
Phone
(972) 223-3944
Fax
(972) 223-7456
NPI assigned
May 15, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

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) 348-8959

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1101 N Hampton Rd
Desoto, TX 75115-3951

Mailing address

4150 International PLZ Ste 200
Fort Worth, TX 76109-4875
Phone (817) 348-8959

Other names 1

  • DeSoto Nursing & Rehabilitation Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250815001628 TX Part A Provider - Skilled Nursing Facility 2264931401 Practice locations: Desoto, TX

Skilled nursing facility certification: CCN 455994

Legal name
DESOTO II ENTERPRISES, LLC
Doing business as
DESOTO NURSING & REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Feb 7, 1992
Last certification
Nov 21, 2024
Beds
110
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
1101 North Hampton Rd
Desoto, TX 75115-3951
Nursing home name
DESOTO NURSING & REHABILITATION CENTER
Affiliated entity
CREATIVE SOLUTIONS IN HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Desoto Nursing & Rehabilitation CenterCCN 455994
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Feb 7, 1992
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
11079.6 residents per day on average
Chain
Creative Solutions in Healthcare149 facilities in the chain
Penalties (3 years)
1Fines totaling $8,281

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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 Interest Jul 1, 2024 50%
Operational/Managerial Control Jul 1, 2024
Managing Control - Governing BodyVice President Jul 5, 2000
Adp of the SNF Jul 1, 2024
Denise Fulton Individual Adp of the SNF Aug 15, 2025
Gary R Blake Individual 5% Or Greater Indirect Ownership Interest Jul 1, 2024 50%
Operational/Managerial Control Jul 1, 2024
Adp of the SNF Jul 1, 2024
Desoto II Enterprises, LLC Organization, Fort Worth, TX LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jul 1, 2024 100%
Operational/Managerial Control Jul 1, 2024
Linda F Huggins Individual Operational/Managerial Control Jul 1, 2024
Managing Control - Governing BodyVice President of Accounts Recei Jul 1, 2024
Adp of the SNF Jul 1, 2024
Anthony Doti Individual Adp of the SNF Aug 15, 2025
Auston Clanton Individual Operational/Managerial Control Jul 1, 2024
Managing Control - Governing BodyChief Operating Officer Jul 1, 2024
Adp of the SNF Jul 1, 2024
Christopher Eamiguel Individual Operational/Managerial Control Jul 1, 2024
Managing Control - Governing BodyChief Financial Officer Jul 1, 2024
Adp of the SNF Jul 1, 2024
Honor X Enterprises, LLC Organization, Fort Worth, TX LLC, Holding company 5% Or Greater Indirect Ownership Interest Jul 1, 2024 100%
Adp of the SNF Aug 15, 2025
Creative Solutions in Healthcare Inc Organization, Fort Worth, TX Corporation, Management services company Operational/Managerial Control Jul 1, 2024
Adp of the SNF Jul 1, 2024
Zachary Willig Individual Operational/Managerial Control Jul 1, 2024
Adp of the SNF Jul 1, 2021

Owners & managing parties with NPI records 1

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

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 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

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": "1715731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715731200000",
    "number": "1700635463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 INTERNATIONAL PLZ STE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094875",
            "telephone_number": "817-348-8959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 N HAMPTON RD",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751153951",
            "telephone_number": "972-223-3944",
            "fax_number": "972-223-7456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESOTO II ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-15",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DeSoto Nursing & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Desoto, TX

Sources for this page

Verify at the official NPI Registry.