1003803123 NPI number — DALEDO CARE CENTERS INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003803123 NPI number — DALEDO CARE CENTERS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALEDO CARE CENTERS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FORREST RIDGE CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003803123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1315 E STATE HIGHWAY 22
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76531-3173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-386-3171
Provider Business Mailing Address Fax Number:
254-386-8261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1315 E STATE HIGHWAY 22
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76531-3173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-386-3171
Provider Business Practice Location Address Fax Number:
254-386-8261
Provider Enumeration Date:
10/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FORREST
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
254-386-3171

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  115088 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 314000000X , with the licence number: 111872 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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