Healthcare Provider Details

I. General information

NPI: 1902096241
Provider Name (Legal Business Name): DALLAS NURSING HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CENTERVILLE RD
DALLAS TX
75228-2634
US

IV. Provider business mailing address

527 PLYMOUTH RD SUITE 412
PLYMOUTH MEETING PA
19462-1641
US

V. Phone/Fax

Practice location:
  • Phone: 214-327-4503
  • Fax: 214-320-2683
Mailing address:
  • Phone: 610-832-2059
  • Fax: 610-834-2937

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: MR. ROBERT A CONNER
Title or Position: MEMBER
Credential:
Phone: 610-832-2059