Provider Demographics
NPI:1972566867
Name:DALLAS COUNTY HOSPITAL DISTRICT
Entity type:Organization
Organization Name:DALLAS COUNTY HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CERISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-590-8006
Mailing Address - Street 1:8505 TECHNOLOGY FOREST PL STE 1004
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1186
Mailing Address - Country:US
Mailing Address - Phone:832-489-9944
Mailing Address - Fax:866-354-8161
Practice Address - Street 1:1301 RICHARDSON DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4648
Practice Address - Country:US
Practice Address - Phone:972-759-2180
Practice Address - Fax:972-759-2186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-11
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116913314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001021316Medicaid
TX180187001OtherMEDICAID CO B
TX001026660Medicaid
TX001026660Medicaid