Provider Demographics
NPI:1346550654
Name:DALLAS COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:DALLAS COUNTY HOSPITAL DISTRICT
Other - Org Name:LAKEWEST REHABILITATION AND SKILLED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND 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 1:3310 W BRAKER LN UNIT 300-902
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-7853
Mailing Address - Country:US
Mailing Address - Phone:512-482-8242
Mailing Address - Fax:
Practice Address - Street 1:2450 BICKERS ST.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212-1507
Practice Address - Country:US
Practice Address - Phone:214-879-0888
Practice Address - Fax:214-879-1090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX131927314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX281855101OtherTPI - MCD CO B
TX001019200Medicaid
TX281855101OtherTPI - MCD CO B