NPIMap

Organization Active NPI

Woodville II Enterprises, LLC

Doing business as Dogwood Trails Manor

  • Skilled Nursing Facility
  • Woodville, TX
National Provider Identifier
1871551622
Registry record updated Aug 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
111622 Issued in TX
Legal business name
WOODVILLE II ENTERPRISES, LLC
Doing business as
Dogwood Trails Manor
Practice address
647 US Highway 190 W
Woodville, TX 75979-6758
Phone
(409) 283-8147
Fax
(409) 283-3919
NPI assigned
May 2, 2006
Last updated
Aug 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2021

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 111622 TX Primary

Addresses

Primary practice location

647 US Highway 190 W
Woodville, TX 75979-6758

Mailing address

647 US Highway 190 W
Woodville, TX 75979-6758
Phone (409) 283-8147

Other identifiers 3

IdentifierTypeStateIssuer
001004816MedicaidTX
170133601MedicaidTX
005312OtherTXVENDOR#

Other names 1

  • Dogwood Trails Manor Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030829000025 TX Part A Provider - Skilled Nursing Facility 3476464892 Practice locations: Woodville, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1871551622. Details of each certification follow.

Skilled nursing facility certification: CCN 675152

Legal name
WOODVILLE II ENTERPRISES, LLC
Doing business as
DOGWOOD TRAILS MANOR
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
May 21, 1993
Last certification
Jul 24, 2024
Beds
90
Ownership / control type
Corporation
Multi-facility organization
Creative Solutions in Healthcare
Organization structure
LLCProprietary
Enrollment address
647 US Highway 190 W
Woodville, TX 75979-6758
Nursing home name
DOGWOOD TRAILS MANOR
Affiliated entity
CREATIVE SOLUTIONS IN HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Dogwood Trails ManorCCN 675152 · All quality measures
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
May 21, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9050.3 residents per day on average
Chain
Creative Solutions in Healthcare149 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
2Fines totaling $23,104

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

647 US Highway 190 W
Woodville, TX 75979
Phone (281) 973-5237

Ownership & related parties

All disclosed owners & managing parties 4

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 Direct Ownership InterestMember Jun 3, 2003 50%
Operational/Managerial ControlMember Jul 1, 2003 50%
Gary R Blake Individual 5% Or Greater Direct Ownership InterestManaging Member Jun 3, 2003 50%
Operational/Managerial ControlManaging Member Jul 1, 2003 50%
Linda F Huggins Individual W-2 Managing EmployeeVP of Accounts Receivable Jul 1, 2003
Creative Solutions in Healthcare Inc Organization, Fort Worth, TX Corporation, Management services company, Non-profit Operational/Managerial Control Jul 1, 2003 100%

Facilities with the same owner 44

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

View all 44

Practitioners & affiliated clinicians

Practitioners 1

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": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630281600000",
    "number": "1871551622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "647 US HIGHWAY 190 W",
            "city": "WOODVILLE",
            "state": "TX",
            "postal_code": "759796758",
            "telephone_number": "409-283-8147",
            "fax_number": "409-283-3919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "647 US HIGHWAY 190 W",
            "city": "WOODVILLE",
            "state": "TX",
            "postal_code": "759796758",
            "telephone_number": "409-283-8147",
            "fax_number": "409-283-3919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODVILLE II ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2021-08-30",
        "certification_date": "2021-08-30",
        "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": "TX",
            "license": "111622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001004816",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "170133601",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VENDOR#",
            "identifier": "005312",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dogwood Trails Manor",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dogwood Trails Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodville, TX

Sources for this page

Verify at the official NPI Registry.