Provider Demographics
NPI:1699972539
Name:DALLAS HOME FOR JEWISH AGED, INC.
Entity type:Organization
Organization Name:DALLAS HOME FOR JEWISH AGED, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-468-6171
Mailing Address - Street 1:6101 OHIO DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2720
Mailing Address - Country:US
Mailing Address - Phone:972-468-6171
Mailing Address - Fax:972-468-6172
Practice Address - Street 1:11409 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6678
Practice Address - Country:US
Practice Address - Phone:214-363-5100
Practice Address - Fax:241-363-5133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112773314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165795901OtherPART B CO-INSURANCE
TX001012220Medicaid
TX165795901OtherPART B CO-INSURANCE