Healthcare Provider Details

I. General information

NPI: 1376706077
Provider Name (Legal Business Name): PRESBYTERIAN VILLAGE NORTH FOREFRONT LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 SKYLINE DR
DALLAS TX
75243-4198
US

IV. Provider business mailing address

8600 SKYLINE DR
DALLAS TX
75243-4198
US

V. Phone/Fax

Practice location:
  • Phone: 214-355-9024
  • Fax: 214-355-9079
Mailing address:
  • Phone: 214-355-9001
  • Fax: 214-355-9050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number000295
License Number StateTX

VIII. Authorized Official

Name: KAREN KIMBERLY JOHNSON-COOK
Title or Position: CORPORATE COMPLIANCE DIRECTOR
Credential: BSN RN
Phone: 214-413-1566