Provider Demographics
NPI:1457791105
Name:DALLAS BEHAVIORAL HEALTHCARE HOSPITAL, LLC
Entity type:Organization
Organization Name:DALLAS BEHAVIORAL HEALTHCARE HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-905-5091
Mailing Address - Street 1:800 KIRNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-2000
Mailing Address - Country:US
Mailing Address - Phone:972-982-0897
Mailing Address - Fax:972-982-0974
Practice Address - Street 1:800 KIRNWOOD DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2000
Practice Address - Country:US
Practice Address - Phone:248-905-5091
Practice Address - Fax:972-982-0974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-26
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX454126Medicare Oscar/Certification