Healthcare Provider Details

I. General information

NPI: 1790963130
Provider Name (Legal Business Name): DALLAS COUNTY HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 WALLS DR
CLEBURNE TX
76033-4045
US

IV. Provider business mailing address

206 WALLS DR
CLEBURNE TX
76033-4045
US

V. Phone/Fax

Practice location:
  • Phone: 817-645-0668
  • Fax: 817-645-0720
Mailing address:
  • Phone: 817-645-0668
  • Fax: 972-899-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number124941
License Number StateTX

VIII. Authorized Official

Name: FREDERICK CERISE
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 214-590-8006