Provider Demographics
NPI:1790744159
Name:DALLAS HOME FOR JEWISH AGED
Entity Type:Organization
Organization Name:DALLAS HOME FOR JEWISH AGED
Other - Org Name:GOLDEN ACRES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLENTUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-490-7251
Mailing Address - Street 1:5100 BELT LINE RD
Mailing Address - Street 2:SUITE 430
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7559
Mailing Address - Country:US
Mailing Address - Phone:972-490-7251
Mailing Address - Fax:972-387-1281
Practice Address - Street 1:2525 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-2634
Practice Address - Country:US
Practice Address - Phone:214-327-4503
Practice Address - Fax:214-320-2683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX675081314000000X
TX313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675081Medicare Oscar/Certification