Provider Demographics
NPI:1417069444
Name:PRESBYTERIAN VILLAGE NORTH FOREFRONT LIVING
Entity Type:Organization
Organization Name:PRESBYTERIAN VILLAGE NORTH FOREFRONT LIVING
Other - Org Name:PRESBYTERIAN VILLAGE NORTH SPECIAL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE COMPLIANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:KIMBERLY
Authorized Official - Last Name:JOHNSON-COOK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:214-413-1566
Mailing Address - Street 1:8600 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4198
Mailing Address - Country:US
Mailing Address - Phone:214-355-9019
Mailing Address - Fax:214-355-9050
Practice Address - Street 1:8600 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4198
Practice Address - Country:US
Practice Address - Phone:214-355-9000
Practice Address - Fax:214-355-9079
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOREFRONT LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000295314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX45D0481417OtherCLIA