Provider Demographics
NPI:1083836357
Name:DALLAS COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:DALLAS COUNTY HOSPITAL DISTRICT
Other - Org Name:PRESTONWOOD REHABILITATION AND NURSING CENTER
Other - Org Type:Doing Business As
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:
Authorized Official - Phone:214-590-8006
Mailing Address - Street 1:2460 MARSH LN
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-1612
Mailing Address - Country:US
Mailing Address - Phone:214-731-5955
Mailing Address - Fax:214-731-5977
Practice Address - Street 1:2460 MARSH LN
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-1612
Practice Address - Country:US
Practice Address - Phone:214-731-5955
Practice Address - Fax:214-731-5977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121948314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001015050Medicaid
TXHH578SOtherBCBS PROVIDER #
676156Medicare Oscar/Certification