1295788560 NPI number — DALLAS CARESERVICES LLC

Table of content: (NPI 1295788560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295788560 NPI number — DALLAS CARESERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALLAS CARESERVICES LLC
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:
Provider Other Organization Name Type Code:
6
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:
1295788560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 HIGH RIDGE RD
Provider Second Line Business Mailing Address:
SUITE 101 AND 103
Provider Business Mailing Address City Name:
BOYNTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33426-8725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-244-0220
Provider Business Mailing Address Fax Number:
561-244-0222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6310 LBJ FWY
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75240-6401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-866-8800
Provider Business Practice Location Address Fax Number:
972-866-8801
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOCHHAUSER
Authorized Official First Name:
MAXINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
561-244-0220

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 67-9578 . This is a "MEDICARE PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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