Provider Demographics
NPI:1861637092
Name:DALLAS COUNTY JUVENILE DEPARTMENT
Entity Type:Organization
Organization Name:DALLAS COUNTY JUVENILE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-698-4325
Mailing Address - Street 1:2600 LONE STAR DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75212-6336
Mailing Address - Country:US
Mailing Address - Phone:214-698-4325
Mailing Address - Fax:214-698-4325
Practice Address - Street 1:2600 LONE STAR DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212-6336
Practice Address - Country:US
Practice Address - Phone:214-698-4325
Practice Address - Fax:214-698-4325
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF DALLAS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159952401Medicaid