Provider Demographics
NPI:1750448015
Name:DEKALB HEALTH CARE LLC
Entity Type:Organization
Organization Name:DEKALB HEALTH CARE LLC
Other - Org Name:SUNNY ACRES NURSING & REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT SPECIALISTS
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:REDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-881-9432
Mailing Address - Street 1:12520 FM 1840
Mailing Address - Street 2:
Mailing Address - City:DE KALB
Mailing Address - State:TX
Mailing Address - Zip Code:75559-1929
Mailing Address - Country:US
Mailing Address - Phone:903-667-2572
Mailing Address - Fax:903-667-5589
Practice Address - Street 1:12520 FM 1840
Practice Address - Street 2:
Practice Address - City:DE KALB
Practice Address - State:TX
Practice Address - Zip Code:75559-1929
Practice Address - Country:US
Practice Address - Phone:903-667-2572
Practice Address - Fax:903-667-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001003424Medicaid
TX4553Medicaid
TX4553Medicaid