Provider Demographics
NPI:1790963130
Name:DALLAS COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:DALLAS COUNTY HOSPITAL DISTRICT
Other - Org Name:RIDGEVIEW REHABILITATION AND SKILLED NURSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CERISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-590-8006
Mailing Address - Street 1:206 WALLS DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-4045
Mailing Address - Country:US
Mailing Address - Phone:817-645-0668
Mailing Address - Fax:972-899-4460
Practice Address - Street 1:206 WALLS DR
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4045
Practice Address - Country:US
Practice Address - Phone:817-645-0668
Practice Address - Fax:817-645-0720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124941314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX199228101OtherMEDICAID CO B TPI
TX001021131Medicaid
TX001021131Medicaid
TX676197Medicare Oscar/Certification