Provider Demographics
NPI:1124028683
Name:TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS
Entity Type:Organization
Organization Name:TEXAS HEALTH PRESBYTERIAN HOSPITAL DALLAS
Other - Org Name:TEXAS HEALTH PRESBYTERIAN HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIZE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, ACNS-BC
Authorized Official - Phone:214-345-1606
Mailing Address - Street 1:9301 N. CENTRAL EXPY
Mailing Address - Street 2:SUITE 675
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0823
Mailing Address - Country:US
Mailing Address - Phone:214-345-4663
Mailing Address - Fax:214-345-1650
Practice Address - Street 1:9301 N. CENTRAL EXPY
Practice Address - Street 2:SUITE 675
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0823
Practice Address - Country:US
Practice Address - Phone:214-345-4663
Practice Address - Fax:214-345-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-27
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0003629251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXK04584442Medicaid
TX45-8444Medicare ID - Type Unspecified