Healthcare Provider Details

I. General information

NPI: 1902140171
Provider Name (Legal Business Name): DALLAS HEALTH CARE CENTER L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2012
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 NW JASPER ST
DALLAS OR
97338-1279
US

IV. Provider business mailing address

377 NW JASPER ST
DALLAS OR
97338-1279
US

V. Phone/Fax

Practice location:
  • Phone: 503-623-5581
  • Fax: 503-623-2901
Mailing address:
  • Phone: 503-623-5581
  • Fax: 503-623-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOY A HAVERKOST
Title or Position: DIRECTOR OF BUSINESS SERVICES
Credential:
Phone: 503-391-7549