1902096241 NPI number — DALLAS NURSING HOME LLC

Table of content: (NPI 1902096241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902096241 NPI number — DALLAS NURSING HOME LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DALLAS NURSING HOME 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:
1902096241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
527 PLYMOUTH RD
Provider Second Line Business Mailing Address:
SUITE 412
Provider Business Mailing Address City Name:
PLYMOUTH MEETING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19462-1641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-832-2059
Provider Business Mailing Address Fax Number:
610-834-2937

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 CENTERVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75228-2634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-327-4503
Provider Business Practice Location Address Fax Number:
214-320-2683
Provider Enumeration Date:
08/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CONNER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
610-832-2059

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 675081 . This is a "MEDICARE PROVIDER (SNF)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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