MEDICARE: DALLAS COUNTY JUVENILE DEPARTMENT

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	251K00000X	Public Health or Welfare Agency		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861637092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALLAS COUNTY JUVENILE DEPARTMENT

Provider Business Mailing Address
First Line	:	2600 LONE STAR DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75212-6336
Country	:	US
Telephone Number	:	214-698-4325
Fax Number	:	214-698-4325

Provider Business Practice Location Address
First Line	:	2600 LONE STAR DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75212-6336
Country	:	US
Telephone Number	:	214-698-4325
Fax Number	:	214-698-4325

Authorized Official
Title or Position	:	MEDICAID SPECIALIST
Name	:	MR. JAMES F. HARRIS
Credential	:
Telephone Number	:	214-698-4325

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	12/02/2008

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Directions to “DALLAS COUNTY JUVENILE DEPARTMENT ” Practice Location

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