MEDICARE: DORSEYSHOUSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center
2	171W00000X	Contractor

General Provider Information

NPI Number	:	1548955735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DORSEYSHOUSE

Provider Business Mailing Address
First Line	:	5415 E LANCASTER AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-6363
Country	:	US
Telephone Number	:	682-328-1214
Fax Number	:	817-446-2444

Provider Business Practice Location Address
First Line	:	5415 E LANCASTER AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-6363
Country	:	US
Telephone Number	:	682-328-1214
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE ADMINISTRATOR
Name	:	MR. CEDRIC IVAN DORSEY
Credential	:
Telephone Number	:	682-328-1214

Provider Enumeration Date	:	04/05/2023
Last Update Date	:	09/05/2025

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Directions to “DORSEYSHOUSE ” Practice Location

Language	Start Address	Practice Location

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