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NPI Code Detail

MEDICARE: DALLAS NURSING HOME LLC

MEDICARE: DALLAS NURSING HOME LLC
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
1314000000XSkilled Nursing Facility

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1675081OTHERTXMEDICARE PROVIDER (SNF)

General Provider Information

NPI Number : 1902096241
Entity Type Code : Organization
Provider Name (Legal Business Name) : DALLAS NURSING HOME LLC
Provider Business Mailing Address
First Line : 527 PLYMOUTH RD
Second Line : SUITE 412
City : PLYMOUTH MEETING
State : PA
Zip : 19462-1641
Country : US
Telephone Number : 610-832-2059
Fax Number : 610-834-2937
Provider Business Practice Location Address
First Line : 2525 CENTERVILLE RD
Second Line :
City : DALLAS
State : TX
Zip : 75228-2634
Country : US
Telephone Number : 214-327-4503
Fax Number : 214-320-2683
Authorized Official
Title or Position : MEMBER
Name : MR. ROBERT A CONNER
Credential :
Telephone Number : 610-832-2059
Provider Enumeration Date : 08/01/2007
Last Update Date : 08/01/2007

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