Healthcare Provider Details

I. General information

NPI: 1790744159
Provider Name (Legal Business Name): DALLAS HOME FOR JEWISH AGED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CENTERVILLE RD
DALLAS TX
75228-2634
US

IV. Provider business mailing address

5100 BELT LINE RD SUITE 430
DALLAS TX
75254-7559
US

V. Phone/Fax

Practice location:
  • Phone: 214-327-4503
  • Fax: 214-320-2683
Mailing address:
  • Phone: 972-490-7251
  • Fax: 972-387-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number675081
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateTX

VIII. Authorized Official

Name: MR. MICHAEL ELLENTUCK
Title or Position: PRESIDENT
Credential:
Phone: 972-490-7251