Provider Demographics
NPI:1043401334
Name:DALLAS NURSING HOME LLC
Entity Type:Organization
Organization Name:DALLAS NURSING HOME LLC
Other - Org Name:GOLDEN ACRES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-832-2059
Mailing Address - Street 1:527 PLYMOUTH RD
Mailing Address - Street 2:SUITE 412
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1641
Mailing Address - Country:US
Mailing Address - Phone:610-832-2059
Mailing Address - Fax:610-834-2937
Practice Address - Street 1:2525 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-2634
Practice Address - Country:US
Practice Address - Phone:214-327-4503
Practice Address - Fax:214-320-2683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118035315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45-1635OtherHOSPICE - MEDICARE
TX00212200OtherHOSPICE - MEDICAID