Provider Demographics
NPI:1003803123
Name:DALEDO CARE CENTERS INC
Entity Type:Organization
Organization Name:DALEDO CARE CENTERS INC
Other - Org Name:FORREST RIDGE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-386-3171
Mailing Address - Street 1:1315 E STATE HIGHWAY 22
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:TX
Mailing Address - Zip Code:76531-3173
Mailing Address - Country:US
Mailing Address - Phone:254-386-3171
Mailing Address - Fax:254-386-8261
Practice Address - Street 1:1315 E STATE HIGHWAY 22
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:TX
Practice Address - Zip Code:76531-3173
Practice Address - Country:US
Practice Address - Phone:254-386-3171
Practice Address - Fax:254-386-8261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115088310400000X
TX111872314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675140Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER