Provider Demographics
NPI:1962400283
Name:NORTHWEST SENIOR HOUSING CORPORATION
Entity type:Organization
Organization Name:NORTHWEST SENIOR HOUSING CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRAINOR
Authorized Official - Suffix:
Authorized Official - Credentials:BBA, MES
Authorized Official - Phone:214-615-7035
Mailing Address - Street 1:8502 EDGEMERE RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-3523
Mailing Address - Country:US
Mailing Address - Phone:214-615-7045
Mailing Address - Fax:214-615-7046
Practice Address - Street 1:8502 EDGEMERE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-3523
Practice Address - Country:US
Practice Address - Phone:214-615-7045
Practice Address - Fax:214-615-7046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114475310400000X
TX114476314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX67-6002Medicare Oscar/Certification