Provider Demographics
NPI:1922095033
Name:SENIOR HEALTH - DALWORTH, LLC
Entity Type:Organization
Organization Name:SENIOR HEALTH - DALWORTH, LLC
Other - Org Name:DALWORTH NURSING AND REHABILITATION CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:REGIONAL CASE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-410-2600
Mailing Address - Street 1:405 DUNCAN PERRY RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5412
Mailing Address - Country:US
Mailing Address - Phone:817-649-3366
Mailing Address - Fax:817-633-3513
Practice Address - Street 1:405 DUNCAN PERRY RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5412
Practice Address - Country:US
Practice Address - Phone:817-649-3366
Practice Address - Fax:817-633-3513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX455872Medicare ID - Type Unspecified